Provider Demographics
NPI:1346907185
Name:JACKSON, ALEXIS DIONNA (LCSWA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DIONNA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:DIONNA
Other - Last Name:PERRY-JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:501 N 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1359
Practice Address - Country:US
Practice Address - Phone:804-828-9452
Practice Address - Fax:804-828-9282
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104100000X
VA374J00000X
VA09040146981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374J00000XNursing Service Related ProvidersDoula