Provider Demographics
NPI:1740706589
Name:CHIANTELLA, GLORIA MICHAELA (LGPC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MICHAELA
Last Name:CHIANTELLA
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 JANE GARTH
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9556
Mailing Address - Country:US
Mailing Address - Phone:410-905-0280
Mailing Address - Fax:
Practice Address - Street 1:5840 BANNEKER RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3156
Practice Address - Country:US
Practice Address - Phone:410-457-3196
Practice Address - Fax:410-457-3197
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7961101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor