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General NPI Number Information
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NPI Number | 1770237265
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Entity Type | Individual
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Provider Name | ASHLEY JACKSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 626 REVOLUTION ST
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3320
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Country | US
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Telephone | 410-620-7161
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Fax | 410-620-7168
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Provider Business Mailing Address
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Address Line | PO BOX 539
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City | PERRYVILLE
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State | MD
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Zip | 21903-5039
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Country | US
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Telephone | 443-466-8727
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 28170
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License Number State | MD
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