Provider Demographics
NPI:1427531532
Name:TRANSFORMATIONAL TELEPSYCHIATRY
Entity type:Organization
Organization Name:TRANSFORMATIONAL TELEPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LATESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-617-1552
Mailing Address - Street 1:1515 REISTERSTOWN RD # 202
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4342
Mailing Address - Country:US
Mailing Address - Phone:410-713-4711
Mailing Address - Fax:410-713-4966
Practice Address - Street 1:1515 REISTERSTOWN RD # 202
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4342
Practice Address - Country:US
Practice Address - Phone:410-713-4711
Practice Address - Fax:410-713-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health