Provider Demographics
NPI:1619323573
Name:AJAVON, GERMAINE (LCPC)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:AJAVON
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 1:632 FREDERICK RD # 200
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4696
Mailing Address - Country:US
Mailing Address - Phone:443-892-0553
Mailing Address - Fax:443-498-9697
Practice Address - Street 1:632 FREDERICK RD # 200
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4696
Practice Address - Country:US
Practice Address - Phone:443-892-0553
Practice Address - Fax:443-498-9697
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8469101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225094200Medicaid