Individual
MIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10 W MADISON ST, BALTIMORE, MD 21201-5239
(443) 438-7863
(443) 957-9485
Mailing address
10814 S WALLACE ST, CHICAGO, IL 60628-3234
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
MD
Other
Enumeration date
01/26/2026
Last updated
01/26/2026
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