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NPI Code Detail

MEDICARE: JUANITA JACKSON LCPC

MEDICARE: JUANITA JACKSON LCPC
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 Counselor0701008926VA
2101YM0800XMental Health CounselorLC7981MD
3101YM0800XMental Health CounselorLGPC00202DC

General Provider Information

NPI Number : 1942747555
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUANITA JACKSON LCPC
Provider Business Mailing Address
First Line : 100 WEST RD STE 300
Second Line :
City : TOWSON
State : MD
Zip : 21204-2370
Country : US
Telephone Number : 301-367-1503
Fax Number : 443-451-8214
Provider Business Practice Location Address
First Line : 100 WEST RD STE 300
Second Line :
City : TOWSON
State : MD
Zip : 21204-2370
Country : US
Telephone Number : 434-981-0340
Fax Number : 443-451-8214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2017
Last Update Date : 11/04/2025

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