Individual
MR. LAWRENCE PHILLIP JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6400 GROVEDALE DR STE 100, ALEXANDRIA, VA 22310-2504
(571) 483-5390
Mailing address
5850 GRANITE PKWY STE 600, PLANO, TX 75024-6753
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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