Individual
DOMINIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
34009080A
IN
1041C0700X
Clinical Social Worker
149.028567
IL
1041C0700X
Clinical Social Worker
Primary
34009080A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891382339
NPI
IN
05
—
300049653
—
IN
Enumeration date
12/30/2020
Last updated
02/25/2026
Update your record
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