Provider Demographics
NPI:1952462160
Name:ROSS, ALYCE S (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:ALYCE
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19101 BROOKE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5165
Mailing Address - Country:US
Mailing Address - Phone:240-632-0762
Mailing Address - Fax:240-632-0762
Practice Address - Street 1:19101 BROOKE GROVE CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-5165
Practice Address - Country:US
Practice Address - Phone:240-632-0762
Practice Address - Fax:240-632-0762
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health