Provider Demographics
NPI:1346020609
Name:GARRETT, JEANNE GAYLE (LGPC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:GAYLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 WILLYS DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1436
Mailing Address - Country:US
Mailing Address - Phone:443-758-7268
Mailing Address - Fax:
Practice Address - Street 1:102 OLD SOLOMONS ISLAND RD STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3879
Practice Address - Country:US
Practice Address - Phone:410-266-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP1441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional