Provider Demographics
NPI:1891554499
Name:JAMES, FREDINA MARIA (MED, LGPC)
Entity Type:Individual
Prefix:
First Name:FREDINA
Middle Name:MARIA
Last Name:JAMES
Suffix:
Gender:F
Credentials:MED, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 GILROY RD
Mailing Address - Street 2:
Mailing Address - City:NANJEMOY
Mailing Address - State:MD
Mailing Address - Zip Code:20662-3300
Mailing Address - Country:US
Mailing Address - Phone:240-437-4192
Mailing Address - Fax:
Practice Address - Street 1:8305 GILROY RD
Practice Address - Street 2:
Practice Address - City:NANJEMOY
Practice Address - State:MD
Practice Address - Zip Code:20662-3300
Practice Address - Country:US
Practice Address - Phone:240-437-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-135079-B7R2W3101YS0200X
MDLGP14757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool