Healthcare Provider Details

I. General information

NPI: 1487581898
Provider Name (Legal Business Name): LORENA E GONZALEZ TICAS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

IV. Provider business mailing address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-1458
  • Fax: 301-604-1459
Mailing address:
  • Phone: 301-604-1458
  • Fax: 301-604-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17866
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: