Provider Demographics
NPI:1821455825
Name:EUBANKS, JAY W JR (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:EUBANKS
Suffix:JR
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20300 CIDER BARREL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-2760
Mailing Address - Country:US
Mailing Address - Phone:301-330-5669
Mailing Address - Fax:301-330-5639
Practice Address - Street 1:4 PROFESSIONAL DR
Practice Address - Street 2:#120
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3407
Practice Address - Country:US
Practice Address - Phone:301-330-5669
Practice Address - Fax:301-330-5639
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical