Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC50078330 | DC |
NPI | 1003196676 |
---|---|
Provider Name | Mr. Nigel Damien Jackson |
First Address | Suitland, MD 20746-1918 |
Second Address | Washington, DC 20006-1631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2011 |
Last Update Date | 26/08/2011 |