Dominique Jackson
Behavior Technician in Powder Springs, GA. Individual provider (NPI-1).
NPI number1699544783
StatusActive
Last updated in NPPESDec 29, 2023
Details
- NPI
- 1699544783
- Entity type
- Individual (NPI-1)
- Name
- Dominique Jackson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 29, 2023
- Certification date
- Dec 29, 2023
- Last updated
- Dec 29, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
5330 Rutland CtPowder Springs, GA 30127-4785
Phone 404-913-6337 · Fax 404-393-7473
Mailing address
5330 Rutland CtPowder Springs, GA 30127-4785
Phone 404-913-6337 · Fax 404-393-7473
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All 20 Behavior Technician providers in Powder Springs · All 629 providers in Powder Springs
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