Provider Demographics
NPI:1689446262
Name:AMBALLA, ALANA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:AMBALLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 ELBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-8705
Mailing Address - Country:US
Mailing Address - Phone:443-453-4823
Mailing Address - Fax:
Practice Address - Street 1:7324 ELBRIDGE CT
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-8705
Practice Address - Country:US
Practice Address - Phone:443-453-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30019101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor