Individual
MYSIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
632 FREDERICK RD STE 200, CATONSVILLE, MD 21228-4696
(443) 413-9874
Mailing address
5275 N GEORGE STREET EXT, MANCHESTER, PA 17345-9400
(443) 413-9874
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC11648
MD
101YM0800X
Mental Health Counselor
LGP8492
MD
Other
Enumeration date
06/17/2019
Last updated
12/17/2021
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