Healthcare Provider Details

I. General information

NPI: 1124774419
Provider Name (Legal Business Name): DEBORAH ANNE WOODEND STENGER LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 ROUTE 108 STE A
COLUMBIA MD
21045-1990
US

IV. Provider business mailing address

9030 ROUTE 108 STE A
COLUMBIA MD
21045-1990
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax: 410-740-2503
Mailing address:
  • Phone: 410-740-1901
  • Fax: 410-740-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP11876
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: