Individual
JERRONTAY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW, QMHP-C
Contact information
Practice address
200 N 22ND ST, RICHMOND, VA 23223-7020
(804) 644-9590
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
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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