Healthcare Provider Details

I. General information

NPI: 1851524912
Provider Name (Legal Business Name): RUTH CLARIE JACKSON-HAYES M.A., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 COPLEY AVE
WALDORF MD
20602-2805
US

IV. Provider business mailing address

938 COPLEY AVE
WALDORF MD
20602-2805
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-9123
  • Fax:
Mailing address:
  • Phone: 301-675-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC629
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC629
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: