Provider Demographics
NPI:1245734250
Name:MANKYE, JERI MICHELE (LCPC, LCADCAS)
Entity type:Individual
Prefix:MS
First Name:JERI
Middle Name:MICHELE
Last Name:MANKYE
Suffix:
Gender:F
Credentials:LCPC, LCADCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 RADNOR AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:443-540-1191
Mailing Address - Fax:
Practice Address - Street 1:814 RADNOR AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:443-540-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8326101YA0400X, 101YP2500X, 101YM0800X
MDAC2198101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1265486740OtherNATIONAL PROVIDER NUMBER
MD818032601Medicaid