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General NPI Number Information
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NPI Number | 1164148094
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Entity Type | Organization
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Legal Business Name | JERICA COUNSELING, LLC
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 26902 BLACK HORSE RUN
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City | SALISBURY
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State | MD
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Zip | 21801-2273
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Country | US
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Telephone | 443-401-3159
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Fax |
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Provider Business Mailing Address
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Address Line | 2636 N SALISBURY BLVD # 1016
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City | SALISBURY
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State | MD
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Zip | 21801-2141
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Country | US
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Telephone | 443-401-3159
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | VILMA BLACK
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Credential | LGP, LCADC
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Telephone | 443-401-3159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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