Provider Demographics
NPI:1518743939
Name:RICKELS, JESSICA MAE (LMSW, CAC-AD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAE
Last Name:RICKELS
Suffix:
Gender:F
Credentials:LMSW, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3218
Mailing Address - Country:US
Mailing Address - Phone:813-545-4112
Mailing Address - Fax:
Practice Address - Street 1:9956 N MAIN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1077
Practice Address - Country:US
Practice Address - Phone:667-288-1566
Practice Address - Fax:410-429-1399
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC2942101YA0400X
MD27491104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)