Provider Demographics
NPI:1710490826
Name:HAMELIN, GLORIA (LCPC NCC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:HAMELIN
Suffix:
Gender:F
Credentials:LCPC NCC
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:ODONGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, NCC
Mailing Address - Street 1:6918 HEIDELBURG RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4603
Mailing Address - Country:US
Mailing Address - Phone:484-995-1496
Mailing Address - Fax:
Practice Address - Street 1:6918 HEIDELBURG RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4603
Practice Address - Country:US
Practice Address - Phone:484-995-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD171049026Medicaid