Provider Demographics
NPI:1386389807
Name:JACKSON, DELQWAN RASHAWN (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:DELQWAN
Middle Name:RASHAWN
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GLENBURNIE LN APT 103
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3073
Mailing Address - Country:US
Mailing Address - Phone:919-908-3072
Mailing Address - Fax:
Practice Address - Street 1:110 GLENBURNIE LN APT 103
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3073
Practice Address - Country:US
Practice Address - Phone:919-908-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0169021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical