Jacqualine Polydoros, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LC16950 Issued in MD

Practice address

322 E Antietam St Ste 101
Hagerstown, MD 21740-5736

Phone

(301) 733-2431

NPI assigned

Nov 30, 2020

Last updated

Dec 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  DC

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1396349379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20115 PROFESSIONAL BLVD STE 203",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426832",
            "telephone_number": "866-287-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 E ANTIETAM ST STE 101",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405736",
            "telephone_number": "301-733-2431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLYDOROS",
        "first_name": "JACQUALINE",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-30",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC16950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Podiatry Associates of Hagerstown
• Podiatry Associates of Hagerstown
• Podiatry Associates PA
• Christina Clarissa Poh, DO
• Jenna Polk
• Ever Ivan Ponciano, M.D.
• Ashley Marie Pondo, CRNP
• Milad L Pooran, M.D.
• Kristi Pope
• Richard Joseph Porac, D.D.S.

• Mental Health Counselor in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.