Provider Demographics
NPI:1033617204
Name:MORELAND, DENISE ELAINE (LCPC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ELAINE
Last Name:MORELAND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8449 BAY DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2937
Mailing Address - Country:US
Mailing Address - Phone:240-281-8482
Mailing Address - Fax:
Practice Address - Street 1:570 RITCHIE HWY STE H
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2925
Practice Address - Country:US
Practice Address - Phone:410-975-0067
Practice Address - Fax:410-975-0204
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional