Healthcare Provider Details

I. General information

NPI: 1215853502
Provider Name (Legal Business Name): ANGELA DENISE MELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 FORBES BLVD
LANHAM MD
20706-4333
US

IV. Provider business mailing address

5204 LAMPREY CT
WALDORF MD
20603-4218
US

V. Phone/Fax

Practice location:
  • Phone: 240-375-9165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: