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General NPI Number Information
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NPI Number | 1588520563
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Entity Type | Organization
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Legal Business Name | JACKSONS JUBILEE LLC
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 4317 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-3118
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Country | US
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Telephone | 443-653-9506
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Fax | 410-275-0992
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Provider Business Mailing Address
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Address Line | 4317 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-3118
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Country | US
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Telephone | 443-653-9506
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Fax | 410-275-0992
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Authorized Official
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Title or Position | CEO
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Name | SAMANTHA JACKSON
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Credential |
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Telephone | 443-653-9506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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