Provider Demographics
NPI:1255813960
Name:MOTT, JESSICA P (LCSW-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:P
Last Name:MOTT
Suffix:
Gender:F
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 1:9199 REISTERSTOWN RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4513
Mailing Address - Country:US
Mailing Address - Phone:410-356-9208
Mailing Address - Fax:443-200-0267
Practice Address - Street 1:1311 LONDONTOWN BLVD STE 130A
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6439
Practice Address - Country:US
Practice Address - Phone:410-356-9200
Practice Address - Fax:443-200-0267
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical