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Individual

ANDREA LANE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICSW, LCSW

Contact information

Practice address
1763 COLUMBIA RD NW STE 175, WASHINGTON, DC 20009-2891
(202) 318-3997
(202) 318-0501
Mailing address
1763 COLUMBIA RD NW STE 175, WASHINGTON, DC 20009-2891
(202) 381-3997

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
087822
NY
1041C0700X
Clinical Social Worker
0904017420
VA
1041C0700X
Clinical Social Worker
091378
NY
1041C0700X
Clinical Social Worker
Primary
LC200003614
DC

Other

Enumeration date
06/18/2017
Last updated
08/18/2025
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