Provider Demographics
NPI:1255862595
Name:JACKSON TODD, ANJELICA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANJELICA
Middle Name:E
Last Name:JACKSON TODD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 ORCHARD ORIOLE WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3121
Mailing Address - Country:US
Mailing Address - Phone:240-535-9855
Mailing Address - Fax:
Practice Address - Street 1:650 PENNSYLVANIA AVE SE STE 440
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4424
Practice Address - Country:US
Practice Address - Phone:202-544-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
05739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist