Individual
DOMINIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3946 EASTLAND AVE, GREENSBORO, NC 27401-4602
(336) 324-3310
Mailing address
3946 EASTLAND AVE, GREENSBORO, NC 27401-4602
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/01/2025
Last updated
09/01/2025
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