Individual
SHANTIUS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2400 QUEENS CHAPEL RD APT 402, HYATTSVILLE, MD 20782-3637
(305) 345-5401
Mailing address
2400 QUEENS CHAPEL RD APT 402, HYATTSVILLE, MD 20782-3637
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
06/23/2017
Last updated
06/23/2017
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