Provider Demographics
NPI:1275955593
Name:GARRETT, JEROME D SR (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:D
Last Name:GARRETT
Suffix:SR
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 PATRIOTS WAY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5101
Mailing Address - Country:US
Mailing Address - Phone:302-312-7141
Mailing Address - Fax:
Practice Address - Street 1:402 PATRIOTS WAY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5101
Practice Address - Country:US
Practice Address - Phone:302-312-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional