Provider Demographics
NPI:1821488578
Name:JACKSON, SHARRYL
Entity Type:Individual
Prefix:
First Name:SHARRYL
Middle Name:
Last Name: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 1:7474 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 730
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3504
Mailing Address - Country:US
Mailing Address - Phone:202-345-3236
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 730
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3504
Practice Address - Country:US
Practice Address - Phone:202-345-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176011041C0700X
DCLC500786791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical