Provider Demographics
NPI:1346490786
Name:JENNINGS-POLLARD, DIANA (LMHC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:JENNINGS-POLLARD
Suffix:
Gender:F
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:6100 RADIO STATION RD
Mailing Address - Street 2:
Mailing Address - City:LAPLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:863-557-0123
Mailing Address - Fax:
Practice Address - Street 1:6100 RADION STATION ROAD
Practice Address - Street 2:
Practice Address - City:LAPLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-609-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1346490786Medicaid
FL5256Medicaid
MD1346490786Medicaid