Healthcare Provider Details

I. General information

NPI: 1124427190
Provider Name (Legal Business Name): DELLA RODERICK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 BALTIMORE ANNAPOLIS BLVD # 205.206
GLEN BURNIE MD
21061-3504
US

IV. Provider business mailing address

7477 BALTIMORE ANNAPOLIS BLVD STE 201
GLEN BURNIE MD
21061-3567
US

V. Phone/Fax

Practice location:
  • Phone: 410-412-7791
  • Fax:
Mailing address:
  • Phone: 443-906-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC8303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: