Healthcare Provider Details

I. General information

NPI: 1285274712
Provider Name (Legal Business Name): JILLIAN BLOCK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 PENNSYLVANIA AVE
BALTIMORE MD
21217-3235
US

IV. Provider business mailing address

1413 ANCHOR ST
BALTIMORE MD
21230-4331
US

V. Phone/Fax

Practice location:
  • Phone: 443-602-7804
  • Fax:
Mailing address:
  • Phone: 410-562-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9761
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: