Individual
MS. GIANNA LATRICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GMFT
Contact information
Practice address
2255 CRAIN HWY STE 107, WALDORF, MD 20601-3186
(301) 292-2778
Mailing address
PO BOX 644, TEMPLE HILLS, MD 20757-0644
(619) 944-9971
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
164X00000X
Licensed Vocational Nurse
223042
CA
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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