Provider Demographics
NPI:1124314117
Name:JACKSON, FAIZA OMER (LCSW)
Entity type:Individual
Prefix:MS
First Name:FAIZA
Middle Name:OMER
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7644 AUDUBON MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2277
Mailing Address - Country:US
Mailing Address - Phone:713-933-8903
Mailing Address - Fax:
Practice Address - Street 1:300 N WASHINGTON ST STE 607
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2544
Practice Address - Country:US
Practice Address - Phone:713-933-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.012194104100000X
MD231891041C0700X
VA09040108311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker