Provider Demographics
NPI:1689204695
Name:MANN, STEPHEN LYNDELL (LGP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LYNDELL
Last Name:MANN
Suffix:
Gender:M
Credentials:LGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CHISWELL LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1115
Mailing Address - Country:US
Mailing Address - Phone:410-370-0202
Mailing Address - Fax:301-579-2400
Practice Address - Street 1:13400 EDGEMEADE RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8088
Practice Address - Country:US
Practice Address - Phone:240-681-6000
Practice Address - Fax:301-579-2400
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10004OtherLICENSED GRADUATE PROFESSIONAL COUNSELOR