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Jackson Professional Serv Llc
Adolescent and Children Mental Health Clinic/Center in Petersburg, Virginia
NPI 1922761352

Jackson Professional Serv Llc is an Adolescent and Children Mental Health Clinic/Center based in Petersburg, VA and is specialized in Adolescent and Children Mental Health. Jackson Professional Serv Llc practices in Petersburg, VA. The NPI Number for Jackson Professional Serv Llc is 1922761352 and holds a License No. (Virginia).

The current practice location address for Jackson Professional Serv Llc is 420 Pine Ridge Rd, Petersburg, VA and can be reached out via phone at 804-714-5998. You can also correspond with Jackson Professional Serv Llc through the mailing address at 420 PINE RIDGE RD, PETERSBURG, VA - 23805-1320 (mailing address contact number: ).

Location: 420 Pine Ridge Rd, Petersburg, VA, 23805-1320
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1922761352
Provider Name
Jackson Professional Serv Llc
Credential
Provider Entity Type
Organization
Address
420 Pine Ridge Rd, Petersburg, VA, 23805-1320
Phone Number
804-714-5998
Fax Number
Provider Enumeration Date
10/21/2021
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0709024300 05 VA
0733006270 01 VA QMHP
0733006270 05 VA
0709024300 01 VA SUBSTANCE ABUSE
0732008263 01 VA QMHP ADULT
institution
Provider Business Practice Location Address Details
Address
420 Pine Ridge Rd
City
Petersburg
State
Virginia
Zip
23805-1320
Phone Number
804-714-5998
Fax Number
person
Provider Business Mailing Address Details
Address
420 Pine Ridge Rd
City
Petersburg
State
Virginia
Zip
23805-1320
Phone Number
804-714-5998
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Other Service Providers
Classification
Community Health Worker
Speciality
-
Taxonomy
172V00000X
License No.
()
Definition
Community health workers (CHW) are lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve. They have been identified by many titles such as community health advisors, lay health advocates, "promotores(as), outreach educators, community health representatives, peer health promoters, and peer health educators. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening. Some examples of these practitioners are Community Health Aides or Practitioners established under 25 USC 1616 (l) under HHS, Indian Health Service, Public Health Service.
person
Provider's Taxonomy Details 4
Type
Agencies
Classification
Community/Behavioral Health
Speciality
-
Taxonomy
251S00000X
License No.
()
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
person
Provider's Taxonomy Details 5
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adolescent and Children Mental Health
Taxonomy
261QM0855X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
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