Healthcare Provider Details

I. General information

NPI: 1548563075
Provider Name (Legal Business Name): ELENA KELLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S NORTH POINT RD
BALTIMORE MD
21224-3338
US

IV. Provider business mailing address

810 BESTGATE RD STE 325
ANNAPOLIS MD
21401-4291
US

V. Phone/Fax

Practice location:
  • Phone: 443-216-4800
  • Fax: 443-216-4801
Mailing address:
  • Phone: 667-408-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: