Individual
JACQUELINE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
5144 DOUBS RD, ADAMSTOWN, MD 21710-8919
(240) 397-4356
Mailing address
5144 DOUBS RD, ADAMSTOWN, MD 21710-8919
(240) 397-4356
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
28071
MD
1041C0700X
Clinical Social Worker
0904017476
VA
1041C0700X
Clinical Social Worker
Primary
28071
MD
Other
Enumeration date
12/05/2021
Last updated
02/06/2026
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