Individual
JESSICA TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
107 E 25TH ST, BALTIMORE, MD 21218-5213
(410) 558-0019
Mailing address
5630 GOVANE AVE, BALTIMORE, MD 21212-3911
(443) 564-7794
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
23141
MD
Other
Enumeration date
04/29/2019
Last updated
04/29/2019
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