Provider Demographics
NPI:1184120909
Name:RAGLAND, MAX TRACEY (EDD, LCPC)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:TRACEY
Last Name:RAGLAND
Suffix:
Gender:M
Credentials:EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BROOKFIELD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-5310
Mailing Address - Country:US
Mailing Address - Phone:443-924-0455
Mailing Address - Fax:
Practice Address - Street 1:2501 BROOKFIELD AVE APT 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-5310
Practice Address - Country:US
Practice Address - Phone:443-924-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health