MEDICARE: ROSALEE STURDIVANT

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	LGP17335	MD

General Provider Information

NPI Number	:	1831054543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALEE STURDIVANT

Provider Business Mailing Address
First Line	:	7615 GUNMILL LN
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21060-8626
Country	:	US
Telephone Number	:	443-228-6741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5740 EXECUTIVE DR STE 108
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-1331
Country	:	US
Telephone Number	:	443-228-6741
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ ROSALEE STURDIVANT ” Practice Location

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