Provider Demographics
NPI:1821259631
Name:JACKSON-GARNETT, KIA M (MSW, LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:M
Last Name:JACKSON-GARNETT
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8282 QUILL POINT DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4390
Mailing Address - Country:US
Mailing Address - Phone:301-602-0168
Mailing Address - Fax:301-352-0032
Practice Address - Street 1:8282 QUILL POINT DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4390
Practice Address - Country:US
Practice Address - Phone:301-602-0168
Practice Address - Fax:301-352-0032
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3030721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical