Provider Demographics
NPI:1609004886
Name:TAYLOR, JENNIFER 'JENNA' S (NCC, LGPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER 'JENNA'
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NCC, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5409
Mailing Address - Country:US
Mailing Address - Phone:301-745-1900
Mailing Address - Fax:
Practice Address - Street 1:113 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5409
Practice Address - Country:US
Practice Address - Phone:301-745-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health