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NPI Code Detail

MEDICARE: FEDELINE APPOLON LCPC, NCC

MEDICARE: FEDELINE APPOLON LCPC, NCC
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
1101YP2500XProfessional CounselorLC15233MD

General Provider Information

NPI Number : 1578174900
Entity Type Code : Individual
Provider Name (Legal Business Name) : FEDELINE APPOLON LCPC, NCC
Provider Business Mailing Address
First Line : 9861 BROKEN LAND PKWY STE 100
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3031
Country : US
Telephone Number : 215-820-5324
Fax Number :
Provider Business Practice Location Address
First Line : 9861 BROKEN LAND PKWY STE 100
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3031
Country : US
Telephone Number : 215-820-5324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2020
Last Update Date : 09/17/2025

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Directions to “ FEDELINE APPOLON LCPC, NCC” Practice Location

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