Provider Demographics
NPI:1225891401
Name:DAIL, JENNIFER (NCC, LPCMH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAIL
Suffix:
Gender:F
Credentials:NCC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-1729
Mailing Address - Country:US
Mailing Address - Phone:302-497-3310
Mailing Address - Fax:
Practice Address - Street 1:116 LAKE DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1729
Practice Address - Country:US
Practice Address - Phone:302-497-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011514101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional