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Individual

DAPHIME JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CSC-AD

Contact information

Practice address
8737 BROOKS DR STE 108, EASTON, MD 21601-7474
(800) 867-2395
(410) 443-0842
Mailing address
PO BOX 123, EASTON, MD 21601-8901
(800) 867-2395
(410) 443-0842

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Enumeration date
06/25/2019
Last updated
08/28/2019
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