Provider Demographics
NPI:1871132233
Name:DUDLEY, PATRICIA (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 BUCKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4103
Mailing Address - Country:US
Mailing Address - Phone:301-537-4740
Mailing Address - Fax:
Practice Address - Street 1:6659 BUCKSTONE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4103
Practice Address - Country:US
Practice Address - Phone:301-537-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC8140OtherMD BOARD OF PROFESSIONAL COUNSELORS & THERAPISTS