Provider Demographics
NPI:1952070633
Name:PROVELENGIOS, LINDSEY (LCPC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:PROVELENGIOS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 ROMAN RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-1894
Mailing Address - Country:US
Mailing Address - Phone:443-547-4800
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR STE 1A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4266
Practice Address - Country:US
Practice Address - Phone:443-266-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9036101YP2500X
MDLC12399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional