Provider Demographics
NPI:1770175507
Name:JACKSON, JOHN ARTHUR III (MA, NCC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ARTHUR
Last Name:JACKSON
Suffix:III
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20848-0669
Mailing Address - Country:US
Mailing Address - Phone:301-452-4002
Mailing Address - Fax:
Practice Address - Street 1:7050 CHESAPEAKE RD STE 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2345
Practice Address - Country:US
Practice Address - Phone:240-770-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health