MEDICARE: ASHLEIGH CAMILLE 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
1	101YM0800X	Mental Health Counselor	0701015388	VA

General Provider Information

NPI Number	:	1932968542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEIGH CAMILLE JACKSON

Provider Business Mailing Address
First Line	:	6524 WOODLAKE VILLAGE CIR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2200
Country	:	US
Telephone Number	:	540-699-0226
Fax Number	:

Provider Business Practice Location Address
First Line	:	4518 BEECH RD STE 230
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6735
Country	:	US
Telephone Number	:	202-643-3592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	10/28/2025

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