NPI 1922870179

Domenica Raegene Nycole Jackson

Practitioner Social Worker Russellville, AL

Practice location

Address: 12260 Highway 43, Russellville, AL 35653-4737
Phone: (256) 710-8558
Mailing address: 238 Lewis St, Muscle Shoals, AL 35661-1630

Registered specialties

Social Worker Primary

Behavioral Health & Social Service Providers Taxonomy 104100000X Licence 6371G (AL)

Other Social Worker providers in Alabama →

Registry record

NPI: 1922870179
Entity type: Individual
Sex (as registered): Female
NPI issued: 23 Oct 2023
Record last updated: 3 Mar 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.