Individual
TANISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9500 ANNAPOLIS RD, A8, LANHAM, MD 20706
(301) 710-9400
Mailing address
9500 ANNAPOLIS RD, LANHAM, MD 20706-2060
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
509417
DC
101YM0800X
Mental Health Counselor
Primary
LC5879
MD
101YP2500X
Professional Counselor
LC5879
MD
Other
Enumeration date
09/25/2017
Last updated
09/25/2017
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