Organization
TRANSFORMATIONAL TELEPSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATESHIA JACKSON (CEO/NURSE PRACTITIONER)
(202) 738-0761
Entity
Organization
Contact information
Practice address
1515 REISTERSTOWN RD, PIKESVILLE, MD 21208-4342
(410) 713-4711
Mailing address
1515 REISTERSTOWN RD # 202, PIKESVILLE, MD 21208-4342
(410) 713-4711
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337410ZBP8708339
—
MD
Enumeration date
10/31/2018
Last updated
08/15/2025
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