MEDICARE: MCKALAH HUDLIN LGPC

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	101YM0800X	Mental Health Counselor	LGP14270	MD

General Provider Information

NPI Number	:	1366298622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKALAH HUDLIN LGPC

Provider Business Mailing Address
First Line	:	3850 BOSTON ST APT 4020
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 BOSTON ST APT 4020
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5770
Country	:	US
Telephone Number	:	571-385-8393
Fax Number	:

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

Provider Enumeration Date	:	04/27/2024
Last Update Date	:	04/27/2024

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