Healthcare Provider Details

I. General information

NPI: 1679042071
Provider Name (Legal Business Name): JUDELINE ALTEMA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7790 ROTHERHAM DR
HANOVER MD
21076-1460
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 700B
GREENBELT MD
20770-3523
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-2742
  • Fax:
Mailing address:
  • Phone: 240-304-3327
  • Fax: 240-513-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP8151
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: