Provider Demographics
NPI:1124647615
Name:SANNEMAN, RADIANCE ALLEN (MS, LPC, NCC, CCMHC)
Entity type:Individual
Prefix:MS
First Name:RADIANCE
Middle Name:ALLEN
Last Name:SANNEMAN
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CCMHC
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:ALLEN
Other - Last Name:SANNEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC, NCC, CCMHC
Mailing Address - Street 1:8507 OXON HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4774
Mailing Address - Country:US
Mailing Address - Phone:301-246-0074
Mailing Address - Fax:
Practice Address - Street 1:8507 OXON HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4774
Practice Address - Country:US
Practice Address - Phone:301-246-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011435101YP2500X
DCPRC200001455101YP2500X
MDLC12394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional