Individual
JACQUELINE LONGLEY BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
1208 E CHURCHVILLE RD STE 300, BEL AIR, MD 21014-3485
(410) 893-4600
(410) 640-4358
Mailing address
726 CROWN PARK AVE, GAITHERSBURG, MD 20878-4515
(407) 376-8977
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LGP6827
MD
101YP2500X
Professional Counselor
Primary
LC11602
MD
Other
Enumeration date
01/27/2019
Last updated
06/30/2021
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