Individual
MS. ANITA RIKKI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSED, BCBA
Contact information
Practice address
14420 W SIDE BLVD APT 310, LAUREL, MD 20707-6271
(301) 318-5429
Mailing address
14420 W SIDE BLVD APT 310, LAUREL, MD 20707-6271
(301) 318-5429
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA612
MD
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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