Individual
JACKSON ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
502 KENNEDY ST NW STE 2-A, WASHINGTON, DC 20011-3136
(802) 999-5792
Mailing address
502 KENNEDY ST NW STE 2-A, WASHINGTON, DC 20011-3136
(802) 999-5792
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
DC
Other
Enumeration date
07/02/2025
Last updated
11/20/2025
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