Provider Demographics
NPI:1396294930
Name:DURST, JERILYN
Entity type:Individual
Prefix:
First Name:JERILYN
Middle Name:
Last Name:DURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GREENE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3089
Mailing Address - Country:US
Mailing Address - Phone:301-724-1697
Mailing Address - Fax:
Practice Address - Street 1:36 GREENE ST STE 101
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3089
Practice Address - Country:US
Practice Address - Phone:301-724-1697
Practice Address - Fax:301-724-1697
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health