Provider Demographics
NPI:1285641050
Name:LANDERS, MICHELLE PATRICE (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PATRICE
Last Name:LANDERS
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 1:1609 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-2005
Mailing Address - Country:US
Mailing Address - Phone:410-688-4189
Mailing Address - Fax:
Practice Address - Street 1:KEY POINT HEALTH SERVICES
Practice Address - Street 2:7702 DUNMANWAY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222
Practice Address - Country:US
Practice Address - Phone:410-282-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP076101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor