Provider Demographics
NPI:1194147827
Name:BURGESS, JANELLE LATRICE (LPC)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:LATRICE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 MERRICK LN
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4627
Mailing Address - Country:US
Mailing Address - Phone:240-423-8723
Mailing Address - Fax:
Practice Address - Street 1:7717 MERRICK LN
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4627
Practice Address - Country:US
Practice Address - Phone:240-423-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional