Provider Demographics
NPI:1124708821
Name:STETSYUK, JONELL IRENE (MS, LGPC)
Entity type:Individual
Prefix:
First Name:JONELL
Middle Name:IRENE
Last Name:STETSYUK
Suffix:
Gender:F
Credentials:MS, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FUNK AVE
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1307
Mailing Address - Country:US
Mailing Address - Phone:301-302-3942
Mailing Address - Fax:
Practice Address - Street 1:16915 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-9570
Practice Address - Country:US
Practice Address - Phone:301-302-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional