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General NPI Number Information
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NPI Number | 1467365247
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Entity Type | Individual
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Provider Name | MELISSA OPHELIA JACKSON MINISTER/CSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 650 PENNSYLVANIA AVE SE STE 370
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City | WASHINGTON
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State | DC
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Zip | 20003-4349
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Country | US
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Telephone | 202-280-7070
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Fax | 571-475-9528
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Provider Business Mailing Address
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Address Line | 10210 WHITE AVE
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City | CLINTON
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State | MD
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Zip | 20735-3753
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Country | US
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Telephone | 240-889-8051
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | DC
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