MEDICARE: PROVERBS 15:22 PERSONAL GROWTH COACHING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033065750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVERBS 15:22 PERSONAL GROWTH COACHING LLC

Provider Business Mailing Address
First Line	:	11321 SNOW OWL PL UNIT A
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-5993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11321 SNOW OWL PL UNIT A
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-5993
Country	:	US
Telephone Number	:	301-467-3863
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND THERAPIST
Name	:	JESSICA N CANTY
Credential	:	LICSW
Telephone Number	:	301-467-3863

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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