Provider Information for 1629109665
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Ms. MARY Y JACKSON LCSW
Sex: Female
NPI: 1629109665
Last Updated: 2025-02-06
Certification Date: 2025-02-06
Certification Date: 2025-02-06
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629109665 | ||||||||||||
| Enumeration Date | 2007-03-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 16 BURGESS LN DURHAM, NC 27707-2933 United States Phone: 919-493-3888 | Fax: | ||||||||||||
| Primary Practice Address | 8181 PROFESSIONAL PL STE 200 LANDOVER, MD 20785-7219 United States Phone: 301-306-4590 | Fax:301-880-0054 | ||||||||||||
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