Provider Demographics
NPI:1679160790
Name:PALMER, JILL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 COLLEGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2532
Mailing Address - Country:US
Mailing Address - Phone:240-413-0388
Mailing Address - Fax:
Practice Address - Street 1:4480 S COBB DR SE STE 503
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6990
Practice Address - Country:US
Practice Address - Phone:404-946-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50079778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker