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Individual

DIARA R JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4610 FURLEY AVE, BALTIMORE, MD 21206-5710
(410) 929-2527
Mailing address
4610 FURLEY AVE, BALTIMORE, MD 21206-5710

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
19666
MD

Other

Enumeration date
06/13/2014
Last updated
06/13/2014
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