Healthcare Provider Details

I. General information

NPI: 1518824747
Provider Name (Legal Business Name): JENNA STAMBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SCHOOL HOUSE AVE STE 101
WESTMINSTER MD
21157-4566
US

IV. Provider business mailing address

7 SCHOOL HOUSE AVE STE 101
WESTMINSTER MD
21157-4566
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-1233
  • Fax: 410-876-1233
Mailing address:
  • Phone: 410-876-1233
  • Fax: 410-876-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17428
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17428
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: