Provider Demographics
NPI:1164193355
Name:FERENZ, JESSICA (LGPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FERENZ
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 1:9022 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1824
Mailing Address - Country:US
Mailing Address - Phone:410-790-3641
Mailing Address - Fax:
Practice Address - Street 1:1420 MERRITT BLVD STE B
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2192
Practice Address - Country:US
Practice Address - Phone:410-698-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional