Healthcare Provider Details

I. General information

NPI: 1831920511
Provider Name (Legal Business Name): DIANE MACK ANCEL CPRP, CFRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 EASTERN AVE
BALTIMORE MD
21224-2115
US

IV. Provider business mailing address

2220 WONDERVIEW RD
LUTHERVILLE TIMONIUM MD
21093-3360
US

V. Phone/Fax

Practice location:
  • Phone: 800-847-6028
  • Fax:
Mailing address:
  • Phone: 443-470-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: