IndividualActive
Gracie Jackson
NPI 1649084351 · Behavior Technician · Centreville, VA
Gracie Jackson is a Behavior Technician provider in Centreville, VA (NPI 1649084351).
Provider details
- NPI number
- 1649084351
- Entity type
- Individual
- Primary specialty
- Behavior TechnicianBehavioral Health & Social Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- BACB1106900 (VA)
Practice location
5830 Stone Ridge Dr
Centreville, VA 20120-2887
Phone: (718) 215-5311
Fax: (718) 865-5165
Street-level locationGet directions
Mailing address
13800 Coppermine Rd
Herndon, VA 20171-6163
Registry dates
- Enumerated
- 2025-02-03
- Last updated
- 2025-02-03
- Certified
- 2025-02-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.