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Individual

BRENDALAN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
9790 FRANKFURT DR, WALDORF, MD 20603-5346
(202) 459-8733
Mailing address
9790 FRANKFURT DR, WALDORF, MD 20603-5346
(202) 459-8733

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
Q3-0000338
DE
1041C0700X
Clinical Social Worker
0904014977
VA
1041C0700X
Clinical Social Worker
LC20002422
DC

Other

Enumeration date
11/05/2021
Last updated
01/20/2024
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