Provider Demographics
NPI:1154717205
Name:SERGOTT-PEARCE, JILL ALEXIS (LCSW-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ALEXIS
Last Name:SERGOTT-PEARCE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 OAK DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3651
Mailing Address - Country:US
Mailing Address - Phone:443-929-9220
Mailing Address - Fax:
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5355
Practice Address - Country:US
Practice Address - Phone:443-929-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical