Individual
EBONY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7311 LOANDA DR, UPPER MARLBORO, MD 20772-4274
(202) 985-9995
Mailing address
239 57TH PL NE, WASHINGTON, DC 20019-6866
(310) 895-6008
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
2299105
DC
Other
Enumeration date
09/30/2025
Last updated
09/30/2025
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