Healthcare Provider Details

I. General information

NPI: 1972946390
Provider Name (Legal Business Name): JESSICA DANIELLE REHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S BROADWAY
BALTIMORE MD
21231-1712
US

IV. Provider business mailing address

14 S BROADWAY
BALTIMORE MD
21231-1712
US

V. Phone/Fax

Practice location:
  • Phone: 410-276-1773
  • Fax: 410-276-2056
Mailing address:
  • Phone: 410-276-1773
  • Fax: 410-276-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC001944
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP5906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: