Provider Demographics
NPI:1295248680
Name:SEDGWICK, JAMIE NICOLE (LCPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:SEDGWICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 SCHEER ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-9725
Mailing Address - Country:US
Mailing Address - Phone:410-714-9659
Mailing Address - Fax:
Practice Address - Street 1:229 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3812
Practice Address - Country:US
Practice Address - Phone:301-733-5858
Practice Address - Fax:301-733-5626
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional