Individual
MS. JACQUETTA BURNSIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1818 NEW YORK AVE NE STE 110, WASHINGTON, DC 20002-1849
(202) 978-1228
Mailing address
620 FARRAGUT PL NE, WASHINGTON, DC 20017-2361
(202) 656-8392
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGPC200001269
DC
101YP2500X
Professional Counselor
LGPC200001269
DC
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
03/11/2022
Last updated
04/25/2026
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