Provider Demographics
NPI:1538612809
Name:RITZ, JACQUELINE LYNNE (LCPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LYNNE
Last Name:RITZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:L
Other - Last Name:RITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC CAC-AD-S
Mailing Address - Street 1:8717 LASALLE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4185
Mailing Address - Country:US
Mailing Address - Phone:443-280-1712
Mailing Address - Fax:410-465-7784
Practice Address - Street 1:7902 FINGERBOARD RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7629
Practice Address - Country:US
Practice Address - Phone:301-874-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9068101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional