Provider Demographics
NPI:1144758483
Name:FELUDU, IMELDA EYI (LCPC)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:EYI
Last Name:FELUDU
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 1:19107 CHERRY BEND DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1851
Mailing Address - Country:US
Mailing Address - Phone:301-916-8815
Mailing Address - Fax:
Practice Address - Street 1:19801 OBSERVATION DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4070
Practice Address - Country:US
Practice Address - Phone:301-754-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional