Provider Demographics
NPI:1891385522
Name:MCCRUDEN, JACQUE (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:
Last Name:MCCRUDEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CONTINENTAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2338
Mailing Address - Country:US
Mailing Address - Phone:667-600-3220
Mailing Address - Fax:
Practice Address - Street 1:1301 CONTINENTAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2338
Practice Address - Country:US
Practice Address - Phone:667-600-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health