Provider Demographics
NPI:1871274761
Name:MONTGOMERY, DEBOREA (LGPC)
Entity type:Individual
Prefix:
First Name:DEBOREA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 HICKORY RIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3868
Mailing Address - Country:US
Mailing Address - Phone:443-387-2763
Mailing Address - Fax:
Practice Address - Street 1:10805 HICKORY RIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3868
Practice Address - Country:US
Practice Address - Phone:410-387-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health