Provider Demographics
NPI:1659080653
Name:UNDERWOOD, JOLENE (MA, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MA, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 WALKING STICK RD APT O
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-8058
Mailing Address - Country:US
Mailing Address - Phone:512-627-1024
Mailing Address - Fax:
Practice Address - Street 1:4960 WALKING STICK RD APT O
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-8058
Practice Address - Country:US
Practice Address - Phone:512-627-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health