Healthcare Provider Details

I. General information

NPI: 1528831260
Provider Name (Legal Business Name): VERONICA FENNELL LGPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
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

10108 COURTLAND DR
CHELTENHAM MD
20623-1235
US

V. Phone/Fax

Practice location:
  • Phone: 301-717-8230
  • Fax:
Mailing address:
  • Phone: 301-717-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP14632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: