Provider Demographics
NPI:1699379271
Name:MOYNIHAN, LENICE CAROL (LGP9776)
Entity Type:Individual
Prefix:
First Name:LENICE
Middle Name:CAROL
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:LGP9776
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 CHARTER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2892
Mailing Address - Country:US
Mailing Address - Phone:443-653-1363
Mailing Address - Fax:
Practice Address - Street 1:10715 CHARTER DR STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2892
Practice Address - Country:US
Practice Address - Phone:443-653-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional