Healthcare Provider Details

I. General information

NPI: 1851582944
Provider Name (Legal Business Name): GUIDELINES COUNSELING PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 DELAWARE RD
FREDERICK MD
21701
US

IV. Provider business mailing address

306 DELAWARE RD
FREDERICK MD
21701
US

V. Phone/Fax

Practice location:
  • Phone: 301-846-0967
  • Fax: 301-846-0443
Mailing address:
  • Phone: 301-846-0967
  • Fax: 301-846-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101990
License Number StateMD

VIII. Authorized Official

Name: MS. JACQUE B JENKINS
Title or Position: PROGRAM DIRECTOR OWNER
Credential: CCDC CAC AD MD
Phone: 301-846-0967