Provider Demographics
NPI:1326874389
Name:ROBERTSON, JERRICA LORRAINE (LGPC)
Entity type:Individual
Prefix:
First Name:JERRICA
Middle Name:LORRAINE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 ORDNANCE CIR APT 404
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1351
Mailing Address - Country:US
Mailing Address - Phone:302-500-1393
Mailing Address - Fax:
Practice Address - Street 1:911 ORDNANCE CIR APT 404
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1351
Practice Address - Country:US
Practice Address - Phone:302-500-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional