Provider Demographics
NPI:1497700470
Name:SOMERVILLE, JACQUELINE E (LCPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-1367
Mailing Address - Country:US
Mailing Address - Phone:301-266-3960
Mailing Address - Fax:301-446-0131
Practice Address - Street 1:9811 MALLARD DR
Practice Address - Street 2:219
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3143
Practice Address - Country:US
Practice Address - Phone:301-266-3960
Practice Address - Fax:301-446-0131
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional