Provider Demographics
NPI:1407311889
Name:JACKSON, TOWANDA MARIA (QMHP)
Entity Type:Individual
Prefix:MISS
First Name:TOWANDA
Middle Name:MARIA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6802 PARAGON PL STE 410
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:844-892-9261
Practice Address - Street 1:6802 PARAGON PL STE 410
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1655
Practice Address - Country:US
Practice Address - Phone:919-358-3730
Practice Address - Fax:844-892-9261
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health