Provider Demographics
NPI:1760040448
Name:BANNER, VERONICA ROJAS (LGPC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ROJAS
Last Name:BANNER
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 1:9600 MILESTONE WAY APT 3047
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4272
Mailing Address - Country:US
Mailing Address - Phone:240-328-7829
Mailing Address - Fax:
Practice Address - Street 1:5010 SUNNYSIDE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2300
Practice Address - Country:US
Practice Address - Phone:301-474-0060
Practice Address - Fax:301-474-0068
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9089101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor