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Individual

TAMARA DOMINIQUE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2218 RHODE ISLAND AVE NE, WASHINGTON, DC 20018-2827
(202) 717-9428
Mailing address
1367 MASSACHUSETTS AVE SE # 2, WASHINGTON, DC 20003-1540
(202) 977-1259

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
172V00000X
Community Health Worker
1023712726
DC

Other

Enumeration date
03/28/2023
Last updated
06/07/2023
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