Provider Demographics
NPI:1093906489
Name:JACKSON, DANNA LEE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:LEE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:443-703-3242
Practice Address - Street 1:3700 FLEET ST
Practice Address - Street 2:STE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4200
Practice Address - Country:US
Practice Address - Phone:410-558-4900
Practice Address - Fax:410-522-5070
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCI990101YP2500X
MDLCA388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)