Provider Demographics
NPI:1841406915
Name:BETHEA JACKSON, GAIL ARNITA (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ARNITA
Last Name:BETHEA JACKSON
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6178 OXON HILL ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745
Mailing Address - Country:US
Mailing Address - Phone:301-567-4751
Mailing Address - Fax:301-567-3856
Practice Address - Street 1:6178 OXON HILL ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:301-567-4751
Practice Address - Fax:301-567-3856
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04824101YM0800X, 1041C0700X
DCLC301228101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical