Healthcare Provider Details

I. General information

NPI: 1962314732
Provider Name (Legal Business Name): DANIELLE RAGINE JACKSON BSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COLLEGE ST
OXFORD NC
27565-2717
US

IV. Provider business mailing address

102 N HACIENDA LN
HENDERSON NC
27537-3706
US

V. Phone/Fax

Practice location:
  • Phone: 919-885-4477
  • Fax:
Mailing address:
  • Phone: 919-885-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024561
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: