Provider Demographics
NPI:1629459888
Name:JACKSON, SHAWAN D PATTERSON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWAN
Middle Name:D PATTERSON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BLEAK HILL PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8870
Mailing Address - Country:US
Mailing Address - Phone:443-386-3325
Mailing Address - Fax:
Practice Address - Street 1:1933 MONTANA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1817
Practice Address - Country:US
Practice Address - Phone:202-842-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC 369101YM0800X
DCPRC369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional