Provider Demographics
NPI:1679244776
Name:EDWARDS, JENNIFER L (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JENNFIER
Other - Middle Name:L
Other - Last Name:MICHENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4020
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-2005
Practice Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4020
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional