Individual
MRS. KEISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
5801 ALLENTOWN RD STE 310, CAMP SPRINGS, MD 20746-4564
(240) 392-2876
Mailing address
12301 WELFORD MANOR DR, UPPER MARLBORO, MD 20772-6045
(202) 486-2152
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC11445
MD
101YM0800X
Mental Health Counselor
LGP8380
MD
Other
Enumeration date
11/09/2018
Last updated
03/28/2022
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