Individual
OLIVIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LGSW
Contact information
Practice address
300 KENTON DR UNIT 3, CHARLESTON, WV 25311-1266
(130) 494-1625
Mailing address
300 KENTON DR UNIT 3, CHARLESTON, WV 25311-1266
(130) 494-1625
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
BP00946718
WV
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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