Provider Demographics
NPI:1528683414
Name:BAMBIL, JACQUELINE (LGPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BAMBIL
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 1:10624 KNOLLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3235
Mailing Address - Country:US
Mailing Address - Phone:571-241-0254
Mailing Address - Fax:484-393-4096
Practice Address - Street 1:10624 KNOLLWOOD CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-3235
Practice Address - Country:US
Practice Address - Phone:571-241-0254
Practice Address - Fax:484-393-4096
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12823101YP2500X
DCPRC200001582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional