Individual
SAMYIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1833 PULASKI HWY, EDGEWOOD, MD 21040-1641
(443) 484-2306
Mailing address
8109 RIDGETOWN DR APT B, NOTTINGHAM, MD 21236-3520
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
24556
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24556
—
MD
Enumeration date
10/18/2019
Last updated
10/18/2019
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