Individual
MS. CRYSTAL I JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGSW-G
Contact information
Practice address
80 INDUSTRIAL PARK DR, SUITE 2B, WALDORF, MD 20602-2760
(202) 716-4104
Mailing address
80 INDUSTRIAL PARK DR, SUITE 2B, WALDORF, MD 20602-2760
(202) 716-4104
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
G13167
MD
Other
Enumeration date
09/10/2010
Last updated
09/10/2010
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