Healthcare Provider Details

I. General information

NPI: 1811315047
Provider Name (Legal Business Name): JESSICA ROSE WEEG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 RITCHIE HWY STE 126
SEVERNA PARK MD
21146-4145
US

IV. Provider business mailing address

815 RITCHIE HWY STE 126
SEVERNA PARK MD
21146-4145
US

V. Phone/Fax

Practice location:
  • Phone: 443-574-5089
  • Fax:
Mailing address:
  • Phone: 443-574-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC5418
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: