Provider Demographics
NPI:1396891461
Name:HYDER, JACQUELYN L (LCPC & LCADC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:L
Last Name:HYDER
Suffix:
Gender:F
Credentials:LCPC & LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 W OLD LIBERTY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9335
Mailing Address - Country:US
Mailing Address - Phone:410-635-8400
Mailing Address - Fax:410-635-8444
Practice Address - Street 1:1636 W OLD LIBERTY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-9335
Practice Address - Country:US
Practice Address - Phone:410-635-8400
Practice Address - Fax:410-635-8444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA046101YA0400X
MDLC0911101YP1600X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health