Healthcare Provider Details

I. General information

NPI: 1306782909
Provider Name (Legal Business Name): NICOLE LYN PELOQUIN LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CHURCHVILLE RD STE 300
BEL AIR MD
21014-3485
US

IV. Provider business mailing address

508 VALLEYWOOD RD
MILLERSVILLE MD
21108-1631
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-8500
  • Fax:
Mailing address:
  • Phone: 831-402-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP17568
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: