MEDICARE: RECIA JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		VA

General Provider Information

NPI Number	:	1144193863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RECIA JACKSON

Provider Business Mailing Address
First Line	:	5508 MORAVIAN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1819
Country	:	US
Telephone Number	:	901-661-3585
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 MORAVIAN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1819
Country	:	US
Telephone Number	:	901-661-3585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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Directions to “ RECIA JACKSON ” Practice Location

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