Basic Information
| Provider Information | |||||||||
| NPI: | 1033617204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORELAND | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8449 BAY DR | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211222937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402818482 | ||||||||
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| Practice Location | |||||||||
| Address1: | 570 RITCHIE HWY STE H | ||||||||
| Address2: | |||||||||
| City: | SEVERNA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211462925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109750067 | ||||||||
| FaxNumber: | 4109750204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC8144 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.