Provider Demographics
NPI:1871296020
Name:HUNDLEY, BO JESSICA (MA, LCPAT)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:JESSICA
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:MA, LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 FAIT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4031
Mailing Address - Country:US
Mailing Address - Phone:410-206-7460
Mailing Address - Fax:
Practice Address - Street 1:10605 CONCORD ST STE 206
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2526
Practice Address - Country:US
Practice Address - Phone:301-861-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health