Provider Demographics
NPI:1710748355
Name:MCALLISTER, ROSETTA (LGADC)
Entity Type:Individual
Prefix:
First Name:ROSETTA
Middle Name:
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:LGADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 E BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1403
Mailing Address - Country:US
Mailing Address - Phone:443-559-7058
Mailing Address - Fax:
Practice Address - Street 1:1421 E BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1403
Practice Address - Country:US
Practice Address - Phone:443-559-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGA2766101YA0400X, 101YM0800X
MD101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral