Healthcare Provider Details

I. General information

NPI: 1225978653
Provider Name (Legal Business Name): JERI GRESHAM MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12138 CENTRAL AVE # 241
MITCHELLVILLE MD
20721-1910
US

IV. Provider business mailing address

12138 CENTRAL AVE # 241
MITCHELLVILLE MD
20721-1910
US

V. Phone/Fax

Practice location:
  • Phone: 833-262-2400
  • Fax: 833-262-2448
Mailing address:
  • Phone: 833-262-2400
  • Fax: 833-262-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: