Provider Demographics
NPI:1770173221
Name:JACKSON, MEGHAN E
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6290
Mailing Address - Country:US
Mailing Address - Phone:301-381-4586
Mailing Address - Fax:
Practice Address - Street 1:4 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6290
Practice Address - Country:US
Practice Address - Phone:301-381-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker