Healthcare Provider Details

I. General information

NPI: 1396891461
Provider Name (Legal Business Name): JACQUELYN L HYDER LCPC & LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 W OLD LIBERTY RD SUITE 1
ELDERSBURG MD
21784-9335
US

IV. Provider business mailing address

1636 W OLD LIBERTY RD SUITE 1
ELDERSBURG MD
21784-9335
US

V. Phone/Fax

Practice location:
  • Phone: 410-635-8400
  • Fax: 410-635-8444
Mailing address:
  • Phone: 410-635-8400
  • Fax: 410-635-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA046
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLC0911
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0911
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC0911
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: