Jackson, Domonique
Jackson, Domonique is an individual health care provider with primary practice located at 752 Blanding Blvd Ste 130 , Orange Park FL 32065-5790. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jackson, Domonique can be contacted via phone (904) 637-5297.Contact Information
Primary practice address
752 Blanding Blvd Ste 130
Orange Park FL 32065-5790
Phone: (904) 637-5297
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X |
Profile Details
| NPI number | 1063950731 |
|---|---|
| LBN Legal business name | Jackson, Domonique |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 2nd, 2017 |
| Last updated | Jun 25th, 2020 - about 6 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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