Provider Demographics
NPI:1821510165
Name:WINNER, JAIME B
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:B
Last Name:WINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30537 POTOMAC WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3180
Mailing Address - Country:US
Mailing Address - Phone:240-466-1499
Mailing Address - Fax:
Practice Address - Street 1:30537 POTOMAC WAY STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3180
Practice Address - Country:US
Practice Address - Phone:240-466-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical