Provider Demographics
NPI:1679092019
Name:EHLKE, JEWNA BONITA (LCPC, LPC, LPC)
Entity type:Individual
Prefix:
First Name:JEWNA
Middle Name:BONITA
Last Name:EHLKE
Suffix:
Gender:F
Credentials:LCPC, LPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 AUTH WAY
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4276
Mailing Address - Country:US
Mailing Address - Phone:301-782-5084
Mailing Address - Fax:
Practice Address - Street 1:5100 AUTH WAY
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4276
Practice Address - Country:US
Practice Address - Phone:301-782-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7692101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical