Provider Demographics
NPI:1053189746
Name:DECOSTER-EDMUNDS, JAMEICE (PSYD)
Entity type:Individual
Prefix:
First Name:JAMEICE
Middle Name:
Last Name:DECOSTER-EDMUNDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JAMEICE
Other - Middle Name:
Other - Last Name:DECOSTER-EDMUNDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:8006 WINGATE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2025
Mailing Address - Country:US
Mailing Address - Phone:240-486-6311
Mailing Address - Fax:
Practice Address - Street 1:8006 WINGATE DR
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2025
Practice Address - Country:US
Practice Address - Phone:240-486-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical