Jacquelyne Gordon, LCPC
Individual provider Active NPI Professional Counselor · Owings, MD
NPI 1194913665 · NPPES record last updated Dec 6, 2007
Key facts
- NPI
- 1194913665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LC2279 (MD)
- Practice address
- 2021 Chaneyville Rd Ste 102
Owings, MD 20736-4348 - Phone
- (410) 286-2833
- Fax
- (410) 286-2834
- NPI assigned
- Oct 10, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Quince Orchard Psychotherapy LLC
Practice addresses (Care Compare)
9707 Key W Ave
Suite 100
Rockville, MD 20850-3992
Phone (240) 750-6467
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240624001932 | DC | Practitioner - Mental Health Counselor | 8224571864 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quince Orchard Psychotherapy LLC | Professional | Current |
Accepting new patients |
| JLG Counseling Services | Current | Accepting new patients | |
| Andrew T Gergely, MD & Associates, LLC | Past | Accepting new patients | |
| Oasis the Mental Health Center, LLC | Past |
Accepting new patients | |
| Quince Orchard Psychotherapy LLC | Past | Accepting new patients |
Locations
1212 E Churchville Rd
Ste 200
Bel Air, MD 21014
Phone (410) 428-0018
10 N Jefferson St
Ste 202
Frederick, MD 21701
Phone (240) 750-6468
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LC2279 | MD | Yes |
Addresses
Primary practice location
2021 Chaneyville Rd Ste 102
Owings, MD 20736-4348
Mailing address
PO Box 630973
Baltimore, MD 21263-0973
Phone (410) 286-2833
Other providers in Owings, MD
- Heather Gaither
- Anna Marie Galterio-Hubbert
- Ayele Gebrehana
- Gerald P Sterner MD & Associates Chartered
- Michele Elcano Gleitsmann
- Rebecca Graham
- Gymfit Health Network, LLC
- Allison Halterman
- Sherri Hammer
- Christine Harding
All providers in Owings, MD · Professional Counselor in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.