Provider Demographics
NPI:1184031676
Name:RAYMOND, JENA
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 STEVENS FOREST RD APT 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3412
Mailing Address - Country:US
Mailing Address - Phone:646-644-5082
Mailing Address - Fax:
Practice Address - Street 1:5602 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 302B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1411
Practice Address - Country:US
Practice Address - Phone:646-644-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional