Provider Demographics
NPI:1356707830
Name:LOVE-JACKSON, JOY MONIQUE (LCPC)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:MONIQUE
Last Name:LOVE-JACKSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:JOY
Other - Middle Name:MONIQUE
Other - Last Name:LOVE-JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:4113 13TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2602
Mailing Address - Country:US
Mailing Address - Phone:202-207-8204
Mailing Address - Fax:
Practice Address - Street 1:9701 APOLLO DR STE 100
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4785
Practice Address - Country:US
Practice Address - Phone:443-203-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional