MEDICARE: MISS RONEISHA JULEIS PRICE LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC9545	MD
2	101YM0800X	Mental Health Counselor	LC9545	MD
3	101YP2500X	Professional Counselor	LC9545	MD

General Provider Information

NPI Number	:	1154945319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RONEISHA JULEIS PRICE LCPC

Provider Business Mailing Address
First Line	:	1357 TRALEE CIR
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2643
Country	:	US
Telephone Number	:	410-370-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1357 TRALEE CIR
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2643
Country	:	US
Telephone Number	:	410-370-1509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	07/10/2020

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