Provider Demographics
NPI:1467983304
Name:HEATON, JENNIFER E (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:HEATON
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HEATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:3750 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-4046
Mailing Address - Country:US
Mailing Address - Phone:301-639-9847
Mailing Address - Fax:
Practice Address - Street 1:3750 UNIVERSITY BLVD W STE 200
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2136
Practice Address - Country:US
Practice Address - Phone:301-338-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7720101YP2500X, 101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)