Healthcare Provider Details

I. General information

NPI: 1619722584
Provider Name (Legal Business Name): JESSICA VILLATORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 MATTHEW HENSON AVE
LANDOVER MD
20785-2731
US

IV. Provider business mailing address

2310 MATTHEW HENSON AVE
LANDOVER MD
20785-2731
US

V. Phone/Fax

Practice location:
  • Phone: 301-640-1366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001908
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: