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General NPI Number Information
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NPI Number | 1972268704
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Entity Type | Individual
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Provider Name | JENNIFER KOCH ROMMEL
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Gender | Female
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Dates
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Enumeration Date | 11/06/2021
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Last Update Date | 11/06/2021
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Provider Practice Location Address
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Address Line | 202 COURSEVALL DR STE 104
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City | CENTREVILLE
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State | MD
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Zip | 21617-2805
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Country | US
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Telephone | 443-262-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 OLD LOVE POINT RD
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2351
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Country | US
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Telephone | 410-353-1026
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2550
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License Number State | MD
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