Basic Information
| Provider Information | |||||||||
| NPI: | 1235534538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAILIN | ||||||||
| FirstName: | DEIDRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LGPC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9475 LOTTSFORD RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016366504 | ||||||||
| FaxNumber: | 3016366509 | ||||||||
| Practice Location | |||||||||
| Address1: | 9475 LOTTSFORD RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016366504 | ||||||||
| FaxNumber: | 3016366509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2014 | ||||||||
| LastUpdateDate: | 10/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LGP5948 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 275435 | 01 | NBCC | OTHER |