Provider Demographics
NPI:1447884234
Name:WEATHER, JANELLE MARIE
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIE
Last Name:WEATHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9666 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1915
Mailing Address - Country:US
Mailing Address - Phone:301-512-5445
Mailing Address - Fax:
Practice Address - Street 1:14201 LAUREL PARK DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:240-360-4765
Practice Address - Fax:240-360-4767
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health