Healthcare Provider Details

I. General information

NPI: 1770237265
Provider Name (Legal Business Name): ASHLEY JACKSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S MAIN ST STE 1C
BEL AIR MD
21014-3978
US

IV. Provider business mailing address

336 S MAIN ST STE 1C
BEL AIR MD
21014-3978
US

V. Phone/Fax

Practice location:
  • Phone: 410-836-0820
  • Fax: 443-403-0734
Mailing address:
  • Phone: 410-836-0820
  • Fax: 443-403-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: