Healthcare Provider Details

I. General information

NPI: 1891554499
Provider Name (Legal Business Name): FREDINA MARIA JAMES MED, LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 GILROY RD
NANJEMOY MD
20662-3300
US

IV. Provider business mailing address

8305 GILROY RD
NANJEMOY MD
20662-3300
US

V. Phone/Fax

Practice location:
  • Phone: 240-437-4192
  • Fax:
Mailing address:
  • Phone: 240-437-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP14757
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCER-135079-B7R2W3
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: