Healthcare Provider Details

I. General information

NPI: 1124507470
Provider Name (Legal Business Name): ALAINA LOUISE VANGELDER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 RIVERSIDE DR
SALISBURY MD
21801
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 443-358-6193
  • Fax: 443-358-6197
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC10622
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: