Individual
ANTOINETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5048 11TH ST NE, WASHINGTON, DC 20017-2848
(202) 570-5774
Mailing address
5048 11TH ST NE, WASHINGTON, DC 20017-2848
(202) 570-5774
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LGPC10802
MD
101YP2500X
Professional Counselor
LGPC00603
DC
101YP2500X
Professional Counselor
Primary
PRC200001270
DC
Other
Enumeration date
07/26/2019
Last updated
11/16/2021
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