Organization
TRANSFORMATIONAL TELEPSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATESHIA JACKSON (NURSE PRACTITIONER)
(202) 617-1552
Entity
Organization
Contact information
Practice address
1515 REISTERSTOWN RD # 202, PIKESVILLE, MD 21208-4342
(410) 713-4711
(410) 713-4966
Mailing address
1515 REISTERSTOWN RD # 202, PIKESVILLE, MD 21208-4342
(410) 713-4711
(410) 713-4966
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/13/2018
Last updated
08/15/2025
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