Individual provider · Type 1 NPI
Shantius Jackson, LPC
Professional Counselor · Hyattsville, MD
NPI number
1780104455
Active
Practice location
2400 Queens Chapel Rd Apt 402
Hyattsville, MD 20782-3637
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | None listed |
Professional Counselor: Definition to come...
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About NPI 1780104455
Shantius Jackson, LPC's National Provider Identifier is 1780104455, issued on Jun 23, 2017. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Hyattsville, MD. The record was last updated on Jun 23, 2017.