=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063719748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA L WEBB LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2011
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 CRAIN HWY STE 206
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20603-4843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-638-2348
-----------------------------------------------------
Fax | 301-885-1978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4921 BRYANTOWN RD
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20601-4241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-537-8635
-----------------------------------------------------
Fax | 301-885-1978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC3826
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------