Provider Demographics
NPI:1336844042
Name:LIN, JESSICA (LGPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13639 HARVEST GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6261
Mailing Address - Country:US
Mailing Address - Phone:240-593-0038
Mailing Address - Fax:
Practice Address - Street 1:19634 CLUB HOUSE ROAD,
Practice Address - Street 2:SUITE 315
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-2088
Practice Address - Country:US
Practice Address - Phone:240-593-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MDLGP13728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional