Healthcare Provider Details

I. General information

NPI: 1538093661
Provider Name (Legal Business Name): KATRINA ANN WILKINS-JACKSON LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 FORT WASHINGTON RD STE 105
FORT WASHINGTON MD
20744-5844
US

IV. Provider business mailing address

10905 FORT WASHINGTON RD STE 105
FORT WASHINGTON MD
20744-5844
US

V. Phone/Fax

Practice location:
  • Phone: 202-758-4898
  • Fax: 301-485-0363
Mailing address:
  • Phone: 202-758-4898
  • Fax: 301-485-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17918
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: