Healthcare Provider Details

I. General information

NPI: 1336838911
Provider Name (Legal Business Name): ERICKA SCHAIBLE JENNINGS LGP15643
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 PICCARD DR STE 110
ROCKVILLE MD
20850-4364
US

IV. Provider business mailing address

11812 KIGGER JACK LN
CLARKSBURG MD
20871-9320
US

V. Phone/Fax

Practice location:
  • Phone: 301-769-5878
  • Fax:
Mailing address:
  • Phone: 610-554-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP15643
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: