Provider Demographics
NPI:1225735442
Name:DENNISON, JESSICA ANNE (MED, NCC, LGPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNE
Last Name:DENNISON
Suffix:
Gender:F
Credentials:MED, NCC, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENWAY ST NW STE 5
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3557
Mailing Address - Country:US
Mailing Address - Phone:410-693-1379
Mailing Address - Fax:
Practice Address - Street 1:175 ADMIRAL COCHRANE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7316
Practice Address - Country:US
Practice Address - Phone:410-571-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13415101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor