Provider Demographics
NPI:1497281661
Name:ROBERTSON, JENNIFER AUGUSTA (MA, LGPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AUGUSTA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14654 KEENELAND CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3779
Mailing Address - Country:US
Mailing Address - Phone:301-602-0575
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 730
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3504
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:301-560-5558
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional