Healthcare Provider Details

I. General information

NPI: 1144151309
Provider Name (Legal Business Name): GEMMA LUNDERGAN LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9891 BROKEN LAND PKWY STE 210
COLUMBIA MD
21046-3001
US

IV. Provider business mailing address

4713 COLUMBIA RD
ELLICOTT CITY MD
21042-5713
US

V. Phone/Fax

Practice location:
  • Phone: 667-220-7868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: