Individual
ANTOINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
9080 BEALE RD, BUILDING 62, 3RD FLOOR, BETHESDA, MD 20889-5633
(301) 319-2587
Mailing address
9080 BEALE RD, BUILDING 62, 3RD FLOOR, BETHESDA, MD 20889-5633
(301) 319-2587
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW133710
PA
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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