Individual
EARLENE SHAVON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7311 LOANDA DR, UPPER MARLBORO, MD 20772-4274
(301) 442-5779
Mailing address
7311 LOANDA DR, UPPER MARLBORO, MD 20772-4274
(301) 442-5779
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
DC
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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