Provider Demographics
NPI:1578302766
Name:JACKSON, DILCIA YOHANA
Entity type:Individual
Prefix:
First Name:DILCIA
Middle Name:YOHANA
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 1:1131 AIRPORT ROAD
Mailing Address - Street 2:N/A
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-422-8026
Mailing Address - Fax:302-422-0701
Practice Address - Street 1:1131 AIRPORT ROAD
Practice Address - Street 2:N/A
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-422-8033
Practice Address - Fax:302-422-0701
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor