Provider Demographics
NPI:1235534538
Name:PAILIN, DEIDRE (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:
Last Name:PAILIN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 LOTTSFORD RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5357
Mailing Address - Country:US
Mailing Address - Phone:301-636-6504
Mailing Address - Fax:301-636-6509
Practice Address - Street 1:9475 LOTTSFORD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5357
Practice Address - Country:US
Practice Address - Phone:301-636-6504
Practice Address - Fax:301-636-6509
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
275435OtherNBCC