Provider Demographics
NPI:1235434416
Name:CALLWOOD JACKSON, JANET
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:CALLWOOD JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13304 KATRINKA DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4733
Mailing Address - Country:US
Mailing Address - Phone:240-476-1450
Mailing Address - Fax:
Practice Address - Street 1:6915 LAUREL BOWIE RD STE 204
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1715
Practice Address - Country:US
Practice Address - Phone:240-476-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14205101YP2500X
MDLC3767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional