Domenica Raegene Nycole Jackson
NPI #1922870179 in Russellville, Alabama
Provider Information
- NPI Number
- 1922870179
- Entity Type
- Individual
- Name
- Domenica Raegene Nycole Jackson
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Social Worker
- Enumeration Date
- Oct 23, 2023
- Last Updated
- Mar 3, 2024
Practice Location
- Address
- 12260 HIGHWAY 43
- City
- Russellville
- State
- Alabama
- ZIP Code
- 35653-4737
- Phone
- (256) 710-8558
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker |
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