Provider Demographics
NPI:1942906672
Name:MEDINA, VALERIE (LGPC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MEDINA
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 1:64 CENTRAL AVE W # 128
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2622
Mailing Address - Country:US
Mailing Address - Phone:240-847-4015
Mailing Address - Fax:
Practice Address - Street 1:64 CENTRAL AVE W # 128
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2622
Practice Address - Country:US
Practice Address - Phone:240-847-4015
Practice Address - Fax:888-690-5305
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13618101YM0800X
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health