Healthcare Provider Details

I. General information

NPI: 1871285312
Provider Name (Legal Business Name): CAROLINE TRELEASE LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 CHINQUAPIN ROUND RD
ANNAPOLIS MD
21401-4006
US

IV. Provider business mailing address

420 CHINQUAPIN ROUND RD
ANNAPOLIS MD
21401-4006
US

V. Phone/Fax

Practice location:
  • Phone: 410-990-1811
  • Fax:
Mailing address:
  • Phone: 410-693-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP13891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: