Provider Demographics
NPI:1063719748
Name:WEBB, JESSICA L (LCPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BRYANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4241
Mailing Address - Country:US
Mailing Address - Phone:301-537-8635
Mailing Address - Fax:301-885-1978
Practice Address - Street 1:3200 CRAIN HWY STE 206
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4843
Practice Address - Country:US
Practice Address - Phone:301-638-2348
Practice Address - Fax:301-885-1978
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC3826OtherLICENSE