Healthcare Provider Details

I. General information

NPI: 1467365247
Provider Name (Legal Business Name): MELISSA OPHELIA JACKSON MINISTER/CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 370
WASHINGTON DC
20003-4349
US

IV. Provider business mailing address

10210 WHITE AVE
CLINTON MD
20735-3753
US

V. Phone/Fax

Practice location:
  • Phone: 202-280-7070
  • Fax: 571-475-9528
Mailing address:
  • Phone: 240-889-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: