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General NPI Number Information
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NPI Number | 1063066397
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Entity Type | Organization
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Legal Business Name | JEMS COUNSELING AND CLINICAL SUPERVISION SERVICES LLC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 5224 HARFORD RD STE B
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City | BALTIMORE
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State | MD
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Zip | 21214-2694
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Country | US
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Telephone | 410-303-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 5224 HARFORD RD STE B
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City | BALTIMORE
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State | MD
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Zip | 21214-2694
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Country | US
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Telephone | 410-303-9229
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEMMA CHONG CHONG QUI
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Credential | MA, LCADC
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Telephone | 410-303-9229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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