Healthcare Provider Details

I. General information

NPI: 1275183295
Provider Name (Legal Business Name): JENNIFER VAN METER LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

9053 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

V. Phone/Fax

Practice location:
  • Phone: 240-810-3790
  • Fax:
Mailing address:
  • Phone: 240-810-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200001753
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: