Healthcare Provider Details

I. General information

NPI: 1154653525
Provider Name (Legal Business Name): TOWANDA JACKSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW SUITE 300
WASHINGTON DC
20006-1602
US

IV. Provider business mailing address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

V. Phone/Fax

Practice location:
  • Phone: 202-809-1174
  • Fax:
Mailing address:
  • Phone: 202-809-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001366
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT000038
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: