Individual
MS. JACQUELINE DALE GRANTLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, NCC
Contact information
Practice address
22776 THREE NOTCH RD STE 210, LEXINGTON PARK, MD 20653-3370
(301) 866-6333
(240) 718-1906
Mailing address
PO BOX 1662, LEXINGTON PARK, MD 20653-1662
(301) 863-8460
(240) 718-1906
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5199
NC
101YM0800X
Mental Health Counselor
Primary
LC4189
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058356100
—
MD
05
—
6103219
—
NC
Enumeration date
05/04/2006
Last updated
08/13/2023
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