Provider Demographics
NPI:1356649594
Name:SPAULDING, MICHAEL DANIEL (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7904 WHITES COVE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2374
Mailing Address - Country:US
Mailing Address - Phone:410-599-7870
Mailing Address - Fax:
Practice Address - Street 1:9881 BROKEN LAND PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1172
Practice Address - Country:US
Practice Address - Phone:410-599-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2727101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional