| Jacksons Jubilee LLC | |
|
4317 Harford Rd Baltimore MD 21214-3118 | |
| (443) 653-9506 | |
| (410) 275-0992 |
| Full Name | Jacksons Jubilee LLC |
|---|---|
| Speciality | Counselor |
| Location | 4317 Harford Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Samantha Jackson (CEO) |
| Authorized Official Contact | 4436539506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacksons Jubilee LLC 4317 Harford Rd Baltimore MD 21214-3118 Ph: (443) 653-9506 | Jacksons Jubilee LLC 4317 Harford Rd Baltimore MD 21214-3118 Ph: (443) 653-9506 |
| NPI Number | 1588520563 |
|---|---|
| Provider Enumeration Date | 01/02/2026 |
| Last Update Date | 01/02/2026 |
| Certification Date | 01/02/2026 |
| Medicare PECOS PAC ID | 7416430772 |
|---|---|
| Medicare Enrollment ID | O20260314000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588520563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (NU) | Primary |
| Provider Name | Samantha Lachelle Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609438225 PECOS PAC ID: 9830566371 Enrollment ID: I20260314000007 |
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