Jackson, Valecia

Jackson, Valecia is an sole proprietor health care provider with primary practice located at 420 Pine Ridge Rd , Petersburg VA 23805-1320. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Jackson, Valecia can be contacted via phone (804) 714-5998.

Contact Information

Primary practice address
420 Pine Ridge Rd Petersburg VA 23805-1320
Phone: (804) 714-5998
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X Virginia
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 0709024300 Virginia

Profile Details

NPI number 1306509724
LBN Legal business name Jackson, Valecia
Credentials CSAC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 21st, 2021
Last updated Oct 21st, 2021 - about 5 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 1306509724 NPPES
Virginia MEDICAID 0709024300
Virginia Other 0709024300

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