Active NPI
Therapy @ 9811 Inc
- Counselor
- Laurel, MD
National Provider Identifier
1376823823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LC2025
- Legal business name
- THERAPY @ 9811 INC
- Practice address
- 9811 Mallard Dr
Suite 210/211
Laurel, MD 20708-3143 - Phone
- (301) 525-3205
- NPI assigned
- Aug 27, 2011
- Last updated
- Nov 1, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jaccqueline Somerville, PSY.D., LCPC
- Title
- Owner/ Ceo
- Phone
- (301) 525-3205
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LC2025 | MD | Primary |
Addresses
Primary practice location
9811 Mallard Dr
Suite 210/211
Laurel, MD 20708-3143
Mailing address
6996 Hanover Pkwy Apt 202
Greenbelt, MD 20770-2244
Phone (443) 852-2641
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ID NUMBER IS TAX ID | Other | MHN | |
| 1875 | Other | CAREFIRST BLUE CROSS BLUE SHIELD | |
| 413473700 | Medicaid | MD | |
| 676619 | Other | VALUE OPTIONS | |
| NO NUMBER ASSIGNED | Other | CORPHEALTH | |
| 676619 | Other | UNITED BEHAVIORAL HEALTH | |
| NO NUMBER ASSIGNED | Other | CERIDIAN EAP | |
| 01217038 | Other | AMERIGROUP MEDICAID | |
| 1875-0001 | Other | CAREFIST FEP | |
| ID NUMBER IS AN NPI | Other | TRICARE | |
| NO NUMBER ASSIGNED | Other | FIRST ADVANTAGE EAP | |
| NO NUMBER ASSIGNED | Other | CAREBRIDGE EAP | |
| NO NUMBER ASSIGNED | Other | INOVA EAP | |
| 55STJE | Other | CAREFIRST OF MARYLAND | |
| 7695828 | Other | AETNA (MHMO, MPPO, MEPO, MCPPO, EAP) |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Professional Counselor
- Laurel, MD
- NPI 1144504648
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314403200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1383264000000",
"number": "1376823823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6996 HANOVER PKWY APT 202",
"city": "GREENBELT",
"state": "MD",
"postal_code": "207702244",
"telephone_number": "443-852-2641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9811 MALLARD DR",
"address_2": "SUITE 210/211",
"city": "LAUREL",
"state": "MD",
"postal_code": "207083143",
"telephone_number": "301-525-3205"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THERAPY @ 9811 INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-08-27",
"last_updated": "2013-11-01",
"status": "A",
"authorized_official_last_name": "SOMERVILLE",
"authorized_official_first_name": "JACCQUELINE",
"authorized_official_title_or_position": "OWNER/ CEO",
"authorized_official_telephone_number": "301-525-3205",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PSY.D., LCPC"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor",
"state": "MD",
"license": "LC2025",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "ID NUMBER IS TAX ID",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST BLUE CROSS BLUE SHIELD",
"identifier": "1875",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "413473700",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "676619",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPHEALTH",
"identifier": "NO NUMBER ASSIGNED",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "676619",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERIDIAN EAP",
"identifier": "NO NUMBER ASSIGNED",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP MEDICAID",
"identifier": "01217038",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIST FEP",
"identifier": "1875-0001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "ID NUMBER IS AN NPI",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST ADVANTAGE EAP",
"identifier": "NO NUMBER ASSIGNED",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREBRIDGE EAP",
"identifier": "NO NUMBER ASSIGNED",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INOVA EAP",
"identifier": "NO NUMBER ASSIGNED",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST OF MARYLAND",
"identifier": "55STJE",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA (MHMO, MPPO, MEPO, MCPPO, EAP)",
"identifier": "7695828",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.