Healthcare Provider Details

I. General information

NPI: 1376893453
Provider Name (Legal Business Name): JESSICA M WATERS LCPC, ACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S CAMP MEADE RD STE 2
LINTHICUM HEIGHTS MD
21090-2766
US

IV. Provider business mailing address

15514 LONG CYPRESS DR
RUSKIN FL
33573-0182
US

V. Phone/Fax

Practice location:
  • Phone: 410-220-5837
  • Fax: 443-378-5773
Mailing address:
  • Phone: 410-220-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12761
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: