Healthcare Provider Details

I. General information

NPI: 1013330158
Provider Name (Legal Business Name): JEFFREY MICHAEL GALECKI LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2014
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 MARYLAND AVE
BALTIMORE MD
21218-5614
US

IV. Provider business mailing address

2117 MARYLAND AVE
BALTIMORE MD
21218-5614
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-2932
  • Fax:
Mailing address:
  • Phone: 410-837-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA2059
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC5512
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: