Provider Demographics
NPI:1275993594
Name:STACHOWIAK, JENNIFER (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STACHOWIAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:139 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-8843
Mailing Address - Country:US
Mailing Address - Phone:443-567-7037
Mailing Address - Fax:
Practice Address - Street 1:139 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-8843
Practice Address - Country:US
Practice Address - Phone:443-567-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health