Individual
SHELBY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 VIRGINIA BEACH BLVD STE 117, VIRGINIA BEACH, VA 23452-1759
(916) 479-4328
Mailing address
128 N BERWICK CRES, VIRGINIA BEACH, VA 23452-2316
(916) 479-4328
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
VA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68-0396223
—
CA
Enumeration date
12/31/2018
Last updated
09/18/2025
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