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General NPI Number Information
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NPI Number | 1740468461
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Entity Type | Individual
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Provider Name | STACEY B JAUNDOO LCPC, LPC
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Gender | Female
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 5457 TWIN KNOLLS RD STE 300-1265
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City | COLUMBIA
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State | MD
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Zip | 21045-3259
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Country | US
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Telephone | 443-712-7114
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Fax |
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Provider Business Mailing Address
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Address Line | 5457 TWIN KNOLLS RD STE 300-1265
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City | COLUMBIA
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State | MD
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Zip | 21045-3259
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC9276
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License Number State | MD
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