Individual
JERRONTAY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
199 LIBERTY ST SW, LEESBURG, VA 20175-2715
(804) 207-6737
Mailing address
200 N 22ND ST, RICHMOND, VA 23223-7020
(804) 644-9590
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0733007407
VA
1041C0700X
Clinical Social Worker
Primary
0906017686
VA
Other
Enumeration date
08/05/2020
Last updated
06/17/2026
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