Provider Demographics
NPI:1467913897
Name:POLANCO, JOHN (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:POLANCO
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 1:7930 BELRIDGE RD APT I
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3617
Mailing Address - Country:US
Mailing Address - Phone:443-226-2691
Mailing Address - Fax:
Practice Address - Street 1:7930 BELRIDGE RD APT I
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3617
Practice Address - Country:US
Practice Address - Phone:443-226-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC10748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health