Individual
JODI LYNN DIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
214 2ND AVE SW, GLEN BURNIE, MD 21061-3465
(443) 710-2324
Mailing address
214 2ND AVE SW, GLEN BURNIE, MD 21061-3465
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12032
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212150600
—
MD
Enumeration date
03/07/2007
Last updated
01/05/2023
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