Individual
RONELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6806 CENTRAL AVE APT 404, CAPITOL HEIGHTS, MD 20743-2781
(240) 437-9516
Mailing address
6806 CENTRAL AVE APT 404, CAPITOL HEIGHTS, MD 20743-2781
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16239708900
—
MD
Enumeration date
07/12/2018
Last updated
07/12/2018
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