Provider Demographics
NPI:1578174900
Name:APPOLON, FEDELINE (LGPC, NCC)
Entity Type:Individual
Prefix:
First Name:FEDELINE
Middle Name:
Last Name:APPOLON
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 NORMANDY WOODS DR APT E
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4235
Mailing Address - Country:US
Mailing Address - Phone:215-820-5324
Mailing Address - Fax:
Practice Address - Street 1:3210 NORMANDY WOODS DR APT E
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4235
Practice Address - Country:US
Practice Address - Phone:215-820-5324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health