Healthcare Provider Details

I. General information

NPI: 1073121323
Provider Name (Legal Business Name): CHALLINA ROBERTS LGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 FORBES BLVD STE 330
LANHAM MD
20706-6309
US

IV. Provider business mailing address

4311 23RD PKWY APT 908
TEMPLE HILLS MD
20748-4462
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-9887
  • Fax: 301-609-9091
Mailing address:
  • Phone: 240-723-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10186
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: