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General NPI Number Information
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NPI Number | 1740799477
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Entity Type | Individual
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Provider Name | JANEL RENEE CUBBAGE LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 5420 KLEE MILL RD S STE 4
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City | ELDERSBURG
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State | MD
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Zip | 21784-9230
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Country | US
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Telephone | 443-328-4946
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Fax |
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Provider Business Mailing Address
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Address Line | 917 ADANA RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-4745
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Country | US
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Telephone | 302-883-1527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP7851
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC10913
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License Number State | MD
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