Healthcare Provider Details

I. General information

NPI: 1720459340
Provider Name (Legal Business Name): LINDSAY JIMMINK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E LEXINGTON ST STE 600
BALTIMORE MD
21202-1711
US

IV. Provider business mailing address

2709 FEDERAL LN
BOWIE MD
20715-2310
US

V. Phone/Fax

Practice location:
  • Phone: 667-260-2933
  • Fax: 301-609-7284
Mailing address:
  • Phone: 301-609-9887
  • Fax: 301-609-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: