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NPI Code Detail

MEDICARE: KITI JACKSON

MEDICARE: KITI JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLC14207MD

General Provider Information

NPI Number : 1174285613
Entity Type Code : Individual
Provider Name (Legal Business Name) : KITI JACKSON
Provider Business Mailing Address
First Line : 14502 GREENVIEW DR STE 500
Second Line :
City : LAUREL
State : MD
Zip : 20708-4245
Country : US
Telephone Number : 240-415-8946
Fax Number :
Provider Business Practice Location Address
First Line : 14502 GREENVIEW DR STE 500
Second Line :
City : LAUREL
State : MD
Zip : 20708-4245
Country : US
Telephone Number : 240-415-8946
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2021
Last Update Date : 03/19/2026

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Directions to “ KITI JACKSON ” Practice Location

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