Basic Information
| Provider Information | |||||||||
| NPI: | 1295248680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEDGWICK | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1404 SCHEER ST | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217169725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107149659 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 229 N POTOMAC ST | ||||||||
| Address2: | |||||||||
| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217403812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017335858 | ||||||||
| FaxNumber: | 3017335626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2017 | ||||||||
| LastUpdateDate: | 11/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC7133 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.