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General NPI Number Information
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NPI Number | 1255862595
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Entity Type | Individual
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Provider Name | ANJELICA E JACKSON TODD PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 650 PENNSYLVANIA AVE SE STE 440
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City | WASHINGTON
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State | DC
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Zip | 20003-4424
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Country | US
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Telephone | 202-544-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 ORCHARD ORIOLE WAY
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City | ODENTON
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State | MD
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Zip | 21113-3121
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Country | US
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Telephone | 240-535-9855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 05739
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License Number State |
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