Provider Demographics
NPI:1427369214
Name:PROCTOR, BELITA AHUNNA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:BELITA
Middle Name:AHUNNA
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:BELITA
Other - Middle Name:AHUNNA
Other - Last Name:ONYESO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRC, MS
Mailing Address - Street 1:4920 NIAGARA ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1103
Mailing Address - Country:US
Mailing Address - Phone:301-439-7191
Mailing Address - Fax:301-439-1169
Practice Address - Street 1:4920 NIAGARA ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1103
Practice Address - Country:US
Practice Address - Phone:301-439-7191
Practice Address - Fax:301-439-1169
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00090096225C00000X
MDLC3004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12121882OtherCAQH
MD321207600Medicaid