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General NPI Number Information
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NPI Number | 1528909736
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Entity Type | Individual
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Provider Name | WANDA SAMUELS-JACKSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 1826 WOODLAWN DR STE 3
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City | GWYNN OAK
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State | MD
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Zip | 21207-4050
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Country | US
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Telephone | 410-800-2121
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Fax | 443-478-4716
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Provider Business Mailing Address
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Address Line | 8626 HAYSHED LN
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City | COLUMBIA
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State | MD
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Zip | 21045-2604
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Country | US
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Telephone | 410-800-2121
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Fax | 443-478-4716
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 21262
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License Number State | MD
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