Healthcare Provider Details

I. General information

NPI: 1679041032
Provider Name (Legal Business Name): MARYANN CHRETIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7452 BALTIMORE ANNAPOLIS BLVD
GLEN BURNIE MD
21061-3547
US

IV. Provider business mailing address

9900 S MAY AVE APT 1223
OKLAHOMA CITY OK
73159-9022
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-1544
  • Fax:
Mailing address:
  • Phone: 301-871-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11024
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLGP9104
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC11024
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: