Individual
SAMANTHA LACHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
4317 HARFORD RD, BALTIMORE, MD 21214-3118
(443) 708-7510
(410) 275-0992
Mailing address
4317 HARFORD RD, BALTIMORE, MD 21214-3118
(410) 275-0994
(410) 275-0992
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC11555
MD
101YP2500X
Professional Counselor
LGP9650
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210292700
—
MD
Enumeration date
07/03/2019
Last updated
06/05/2023
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