Healthcare Provider Details

I. General information

NPI: 1003359332
Provider Name (Legal Business Name): HANNAH ELISE ROSE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

17 GAP HILL DR
FLETCHER NC
28732-9444
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-1348
  • Fax:
Mailing address:
  • Phone: 443-845-1573
  • Fax: 443-787-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP6742
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7930
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: