Provider Demographics
NPI:1376841320
Name:TALBOTT, ROXANNE L
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:L
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 HARPERS FARM RD
Mailing Address - Street 2:APARTMENT C4
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1251
Mailing Address - Country:US
Mailing Address - Phone:301-357-0389
Mailing Address - Fax:
Practice Address - Street 1:4200 EDMONDSON AVE
Practice Address - Street 2:SUITE 200A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1612
Practice Address - Country:US
Practice Address - Phone:877-698-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional