Provider Demographics
NPI:1275923211
Name:FREDERICK, LECHIA (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LECHIA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:LECHIA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5457 TWIN KNOLLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3296
Mailing Address - Country:US
Mailing Address - Phone:410-861-0740
Mailing Address - Fax:434-225-9723
Practice Address - Street 1:1912 LIBERTY RD SPC 30
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6690
Practice Address - Country:US
Practice Address - Phone:410-861-0740
Practice Address - Fax:434-225-9723
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2019095324363LP0808X
MDR225396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty