Provider Demographics
NPI:1376960252
Name:JOE, ALICE (LGPC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:JOE
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 1:1014 W 36TH ST STE 216
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2415
Mailing Address - Country:US
Mailing Address - Phone:410-949-5533
Mailing Address - Fax:
Practice Address - Street 1:1014 W 36TH ST STE 216
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2415
Practice Address - Country:US
Practice Address - Phone:410-949-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist