Provider Demographics
NPI:1346841665
Name:VELENCIA, RAYMOND (LGPC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:VELENCIA
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2679
Mailing Address - Country:US
Mailing Address - Phone:443-462-3423
Mailing Address - Fax:443-462-3090
Practice Address - Street 1:1001 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2679
Practice Address - Country:US
Practice Address - Phone:443-462-3423
Practice Address - Fax:443-462-3090
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA3093101YA0400X
MDLC12376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)