Provider Demographics
NPI:1942605712
Name:LANDA, AVI (LCPC)
Entity Type:Individual
Prefix:
First Name:AVI
Middle Name:
Last Name:LANDA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 YESHIVA LN APT 1C
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1135
Mailing Address - Country:US
Mailing Address - Phone:410-484-6600
Mailing Address - Fax:
Practice Address - Street 1:4445 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-2736
Practice Address - Country:US
Practice Address - Phone:410-484-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health