Healthcare Provider Details

I. General information

NPI: 1700939154
Provider Name (Legal Business Name): JACQUELINE MARIE SEGUE-WILKINS L.C.P.C., N.C.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 TWIN KNOLLS RD SUITE 9
COLUMBIA MD
21045-3257
US

IV. Provider business mailing address

5401 TWIN KNOLLS RD SUITE 9
COLUMBIA MD
21045-3257
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-2848
  • Fax: 410-884-2849
Mailing address:
  • Phone: 410-884-2848
  • Fax: 410-884-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: