Provider Demographics
NPI:1881841369
Name:PAULA MOYLAN LCPC PA
Entity Type:Organization
Organization Name:PAULA MOYLAN LCPC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MPYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC PA
Authorized Official - Phone:410-298-8223
Mailing Address - Street 1:16909 DAISY DELL CT
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1036
Mailing Address - Country:US
Mailing Address - Phone:410-298-8223
Mailing Address - Fax:410-298-8225
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-456-5739
Practice Address - Fax:410-298-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty