Most Relevant Information
Provider Data
| NPI Number: | 1003665688 |
| Provider Name: | MELISSA-IRENE JACKSON LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 0904016287 |
Most Important Dates
| Enumeration Date: | 05/15/2024 |
| Last Updated: | 05/15/2024 |
Provider Practice Location
2219 W MAIN ST
RICHMOND
VA
232204432
Practice Location Phone/Fax
| Phone: | 8042343158 |
| Fax: |
Provider Mailing Location
2219 W MAIN ST
RICHMOND
VA
232204432
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |