Individual
CHANTELL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10440 LITTLE PATUXENT PKWY, COLUMBIA, MD 21044-3561
(410) 220-0768
Mailing address
10440 LITTLE PATUXENT PKWY, COLUMBIA, MD 21044-3561
(410) 220-0768
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/13/2024
Last updated
09/13/2024
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