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Individual

LEONTAY JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
324 37TH ST SE APT 304, WASHINGTON, DC 20019-3142
(202) 808-2437
Mailing address
700 12TH ST SE APT 506, WASHINGTON, DC 20003-2942
(202) 375-0164

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
09/06/2019
Last updated
09/06/2019
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