Individual
DR. LISA RENE' JACKSON-CHERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 DIDINATO DR, CHESTER REGIONAL MEDICAL CENTER, CHESTER, MD 21619
(410) 490-0535
Mailing address
704 CHESTER RIVER DR, GRASONVILLE, MD 21638-1003
(410) 827-4164
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC0403
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OX94
BLUE CROSS BLUE SHIELD
MD
Enumeration date
07/25/2006
Last updated
07/08/2007
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