Provider Demographics
NPI:1851683908
Name:AMMONS, NOREEN (LCPC/LCADC)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:
Last Name:AMMONS
Suffix:
Gender:F
Credentials:LCPC/LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 BANK ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1803
Mailing Address - Country:US
Mailing Address - Phone:443-570-9185
Mailing Address - Fax:
Practice Address - Street 1:4231 POSTAL CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4439
Practice Address - Country:US
Practice Address - Phone:443-570-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2451069000Medicaid