Jackson, Nicole

Jackson, Nicole is an individual health care provider with primary practice located at 3630 George Washington Hwy Ste B-6, Yorktown VA 23693. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Jackson, Nicole can be contacted via phone (757) 768-6878.

Contact Information

Primary practice address
3630 George Washington Hwy Ste B-6 Yorktown VA 23693
Phone: (757) 768-6878
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 0701004259 Virginia

Profile Details

NPI number 1578740023
LBN Legal business name Jackson, Nicole
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 28th, 2008
Last updated Jun 16th, 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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Identifiers

StateTypeNumberIssuer
All States NPI 1578740023 NPPES
Virginia MEDICAID 004945573

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