Provider Demographics
NPI:1093451486
Name:KOLB, JENNAVIEVE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JENNAVIEVE
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4929
Mailing Address - Country:US
Mailing Address - Phone:410-505-0062
Mailing Address - Fax:
Practice Address - Street 1:8181 MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4929
Practice Address - Country:US
Practice Address - Phone:410-505-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25212104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker