Jackson, Darrell M

Jackson, Darrell M is an individual health care provider with primary practice located at 2336 Goddard Parkway , Salisbury MD 21801. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Jackson, Darrell M can be contacted via phone (410) 334-6961.

Contact Information

Primary practice address
2336 Goddard Parkway Salisbury MD 21801
Phone: (410) 334-6961
Fax: (410) 334-6960
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1417035825
LBN Legal business name Jackson, Darrell M
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2006
Last updated Sep 18th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417035825 NPPES
Maryland MEDICAID 609500303
Maryland Other 259147000
Maryland Other 517251
Maryland MEDICAID 609550004
Maryland MEDICAID 609550001
Maryland Other R968
Maryland MEDICAID 609500300
Maryland Other LM49EA

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