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General NPI Number Information
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NPI Number | 1356133953
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Entity Type | Individual
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Provider Name | STEPHANIE JACKSON MSW
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Gender |
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 283 CONSTITUTION DR STE 600
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6760
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Country | US
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Telephone | 757-839-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 321 E MAIN ST UNIT 2006
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City | NORFOLK
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State | VA
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Zip | 23510-1853
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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