MEDICARE: JENNY ANN CHILDERS LGPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LGP7046	MD

General Provider Information

NPI Number	:	1982100434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY ANN CHILDERS LGPC

Provider Business Mailing Address
First Line	:	13813 WAYSIDE DR
Second Line	:
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1348
Country	:	US
Telephone Number	:	301-351-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	10230 NEW HAMPSHIRE AVE STE 201
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1423
Country	:	US
Telephone Number	:	301-351-8607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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