Individual
KITI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14502 GREENVIEW DR STE 500, LAUREL, MD 20708-4245
(240) 415-8946
Mailing address
14502 GREENVIEW DR STE 500, LAUREL, MD 20708-4245
(240) 415-8946
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC14207
MD
101YM0800X
Mental Health Counselor
Primary
LGP11986
MD
Other
Enumeration date
10/12/2021
Last updated
03/19/2026
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