Provider Demographics
NPI:1013505775
Name:JACKSON, DANEKQUA DANIELLE
Entity Type:Individual
Prefix:
First Name:DANEKQUA
Middle Name:DANIELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 DELAWARE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:GLASSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15045-1538
Mailing Address - Country:US
Mailing Address - Phone:412-417-2159
Mailing Address - Fax:
Practice Address - Street 1:500 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2801
Practice Address - Country:US
Practice Address - Phone:412-675-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health