Provider Demographics
NPI:1538296843
Name:CANELAS, CIRA (LCPC)
Entity Type:Individual
Prefix:
First Name:CIRA
Middle Name:
Last Name:CANELAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 EAST WEST HIGWAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-592-7425
Mailing Address - Fax:
Practice Address - Street 1:4401 EAST WEST HIGWAY
Practice Address - Street 2:SUITE 307
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-592-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130859OtherALLIANCE
MD816700100Medicaid
2130859OtherMDIPA
2130859OtherOPTIMUM CHOICE
2130859OtherMAMSI