Provider Demographics
NPI:1407346760
Name:ELKINS, JACQUELYN KISER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KISER
Last Name:ELKINS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:MARIE
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:6524 MACBETH WAY
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6241
Mailing Address - Country:US
Mailing Address - Phone:410-294-5334
Mailing Address - Fax:
Practice Address - Street 1:5058 DORSEY HALL DR STE 103
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7850
Practice Address - Country:US
Practice Address - Phone:410-884-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical