Provider Demographics
NPI:1992192702
Name:HAYGOOD JACKSON, DONNA (EDD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:HAYGOOD JACKSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3912
Mailing Address - Country:US
Mailing Address - Phone:757-229-5022
Mailing Address - Fax:
Practice Address - Street 1:209 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3912
Practice Address - Country:US
Practice Address - Phone:757-229-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional