| Doctor Name: | MRS. CYNTHIA JONES JACKSON |
| NPI Number: | 1063896140 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LC6163 |
| Business Practice Address: | 1314 Southview Dr Apt 116 Oxon Hill, MD - 207454156 |
| Business Phone Number: | 3014565066 |
| Business Fax Number: | |
| Mailing Address: | 1314 Southview Dr Apt 116, OXON HILL |
| State: | MD |
| Postal Code: | 207454156 |
| Phone Number: | 3014565066 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2015 |
| NPI Last Update Date: | 07/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LC6163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |