Provider Demographics
NPI:1316486673
Name:HANSELL, JEANINE (LCPC)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:HANSELL
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 1:101 VODYS CT
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-2075
Mailing Address - Country:US
Mailing Address - Phone:304-702-4220
Mailing Address - Fax:
Practice Address - Street 1:12801 LITTLE ELLIOTT DR
Practice Address - Street 2:APT. 4
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2629
Practice Address - Country:US
Practice Address - Phone:304-702-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional