Provider Demographics
NPI:1972771939
Name:PIERCE, JENNIFER ANN HOUDESHEL (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN HOUDESHEL
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:18314 SHETLAND WAY
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1490
Mailing Address - Country:US
Mailing Address - Phone:240-866-1828
Mailing Address - Fax:
Practice Address - Street 1:18314 SHETLAND WAY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-1490
Practice Address - Country:US
Practice Address - Phone:240-866-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016442900Medicaid