Individual
NICOLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
787 OELLA AVE, ELLICOTT CITY, MD 21043-4727
(443) 720-0090
Mailing address
2213 ROGENE DR APT 101, BALTIMORE, MD 21209-5730
(240) 304-6414
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP12368
MD
Other
Enumeration date
02/23/2022
Last updated
02/23/2022
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