Provider Demographics
NPI:1336535319
Name:WELLINGTON, RODERICK IRVING (LCPC, NCC, CFC)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:IRVING
Last Name:WELLINGTON
Suffix:
Gender:M
Credentials:LCPC, NCC, CFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 CHESAPEAKE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2347
Mailing Address - Country:US
Mailing Address - Phone:301-459-0726
Mailing Address - Fax:301-576-3787
Practice Address - Street 1:7050 CHESAPEAKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-2347
Practice Address - Country:US
Practice Address - Phone:301-459-0726
Practice Address - Fax:301-576-3787
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6249103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent