Provider Demographics
NPI:1982100434
Name:CHILDERS, JENNY ANN (LGPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ANN
Last Name:CHILDERS
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 1:13813 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1348
Mailing Address - Country:US
Mailing Address - Phone:301-351-8607
Mailing Address - Fax:
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE STE 201
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1423
Practice Address - Country:US
Practice Address - Phone:301-351-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional