Healthcare Provider Details

I. General information

NPI: 1629684311
Provider Name (Legal Business Name): LAUREN NICOLE JENKINS LCPC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RIDGELY AVE STE A
ANNAPOLIS MD
21401-1366
US

IV. Provider business mailing address

201 RIDGELY AVE STE A
ANNAPOLIS MD
21401-1366
US

V. Phone/Fax

Practice location:
  • Phone: 301-970-9032
  • Fax:
Mailing address:
  • Phone: 320-197-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12953
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: