Provider Demographics
NPI:1477254373
Name:JETT, NIQUELLE (LPC)
Entity Type:Individual
Prefix:
First Name:NIQUELLE
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 SIMSBURY CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1661
Mailing Address - Country:US
Mailing Address - Phone:301-326-5145
Mailing Address - Fax:
Practice Address - Street 1:1004 SIMSBURY CT
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1661
Practice Address - Country:US
Practice Address - Phone:301-326-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC200001486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health