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JACKSON PROFESSIONAL SERV LLC
NPI 1922761352
Counselor - Addiction (Substance Use Disorder) in Petersburg, VA

Active since October 21, 2021
420 PINE RIDGE RD, PETERSBURG, VA 23805(804) 714-5998 Get Directions Write a Review

NPPES record last updated: October 21, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jackson Professional Serv Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON PROFESSIONAL SERV LLC (NPI 1922761352), doing business as Valecia Jackson, is a healthcare organization registered as an addiction (substance use disorder) in Petersburg, Virginia and active in the NPI registry since October 2021. The organization lists Antoinita C Stokes, Consultant, as its authorized official.

NPPES Registry Identity

NPI1922761352
Entity TypeOrganization
Primary Taxonomy101YA0400X
Legal Business NameJACKSON PROFESSIONAL SERV LLC
Location Address420 PINE RIDGE RDPetersburg, VA 23805-1320
Mailing Address420 Pine Ridge RdPetersburg, VA 23805-1320
Phone(804) 714-5998
Organization SubpartNo
Authorized OfficialAntoinita C StokesConsultant · (804) 613-0087
Enumeration DateOctober 21, 2021
NPPES CertifiedOctober 21, 2021
✔ NPI 1922761352 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedCommunity Health WorkerTaxonomy 172V00000X
Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X
Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X
420 PINE RIDGE RD, Petersburg, VA 23805
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Other Names 1

Doing Business AsValecia Jackson

Other Identifiers 5

Medicaid0709024300VA
Other0732008263VA · Qmhp Adult
Other0733006270VA · Qmhp
Medicaid0733006270VA
Other0709024300VA · Substance Abuse

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VALECIA JACKSON CSAC
Counselor (Addiction (Substance Use Disorder))
420 PINE RIDGE RD
PETERSBURG, VA 23805
Petersburg City (804) 714-5998

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Professional Serv LLC's NPI number?

The NPI number for Jackson Professional Serv LLC is 1922761352. It was assigned to this organization in the NPPES registry on October 21, 2021. The provider is doing business as Valecia Jackson.

Where is Jackson Professional Serv LLC located?

Jackson Professional Serv LLC is located at 420 Pine Ridge Rd, Petersburg, VA 23805. The listed phone number is (804) 714-5998.

What is Jackson Professional Serv LLC's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Jackson Professional Serv LLC was last updated on October 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.