MEDICARE: FREDINA MARIA JAMES MED, 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	101YS0200X	School Counselor	CER-135079-B7R2W3	MD
2	101YP2500X	Professional Counselor	LGP14757	MD

General Provider Information

NPI Number	:	1891554499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDINA MARIA JAMES MED, LGPC

Provider Business Mailing Address
First Line	:	8305 GILROY RD
Second Line	:
City	:	NANJEMOY
State	:	MD
Zip	:	20662-3300
Country	:	US
Telephone Number	:	240-437-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 GILROY RD
Second Line	:
City	:	NANJEMOY
State	:	MD
Zip	:	20662-3300
Country	:	US
Telephone Number	:	240-437-4192
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	11/04/2024

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