Provider Demographics
NPI:1457868481
Name:AVRAM, GEORGIANA (LCPC)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:
Last Name:AVRAM
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 1:8894 STANFORD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5161
Mailing Address - Country:US
Mailing Address - Phone:646-535-8260
Mailing Address - Fax:347-903-6927
Practice Address - Street 1:8894 STANFORD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5161
Practice Address - Country:US
Practice Address - Phone:646-535-8260
Practice Address - Fax:347-903-6927
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10509101YP2500X
NY008398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health