Healthcare Provider Details

I. General information

NPI: 1972415511
Provider Name (Legal Business Name): JESSICA LYNN ATKISSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N STE 119
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

280 STAFFORD RD
PRINCE FREDERICK MD
20678-3582
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax: 410-535-2220
Mailing address:
  • Phone: 410-535-5400
  • Fax: 410-535-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: