Provider Demographics
NPI:1063066397
Name:JEMS COUNSELING AND CLINICAL SUPERVISION SERVICES LLC
Entity type:Organization
Organization Name:JEMS COUNSELING AND CLINICAL SUPERVISION SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEMMA
Authorized Official - Middle Name:CHONG
Authorized Official - Last Name:CHONG QUI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCADC
Authorized Official - Phone:410-303-9229
Mailing Address - Street 1:5224 HARFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2694
Mailing Address - Country:US
Mailing Address - Phone:410-303-9229
Mailing Address - Fax:
Practice Address - Street 1:5224 HARFORD RD STE B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2694
Practice Address - Country:US
Practice Address - Phone:410-303-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1114261450Medicaid
MD1063066397Medicaid