Individual
JESSICA ANN VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LCADC
Contact information
Practice address
145 E MAIN ST, ELKTON, MD 21921-5917
(443) 203-9850
Mailing address
121 HOPEWELL DR, NORTH EAST, MD 21901-3334
(443) 203-9850
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCA3253
MD
101YP2500X
Professional Counselor
LC14779
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
317849800
—
MD
05
—
520202700
—
MD
Enumeration date
05/18/2016
Last updated
11/29/2024
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