Jackson, Jacquelin Antoinette

Jackson, Jacquelin Antoinette is an individual health care provider with primary practice located at 11240 Waples Mill Rd 101, Fairfax VA 22030-6078. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Jackson, Jacquelin Antoinette can be contacted via phone (703) 237-2219.

Contact Information

Primary practice address
11240 Waples Mill Rd 101 Fairfax VA 22030-6078
Phone: (703) 237-2219
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-11-8474 Florida

Profile Details

NPI number 1497058697
LBN Legal business name Jackson, Jacquelin Antoinette
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 9th, 2010
Last updated Aug 3rd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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