Organization
JACKSON THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILANA JACKSON PSYD (OWNER)
(908) 839-7117
Entity
Organization
Contact information
Practice address
405 ALLEGHENY AVE, TOWSON, MD 21204-4256
(908) 839-7117
Mailing address
1 SUNNY MEADOW CT, APT 102, BALTIMORE, MD 21209-1255
(908) 839-7117
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05059
MD
Other
Enumeration date
09/26/2016
Last updated
09/26/2016
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