Provider Demographics
NPI:1386488823
Name:MOHANTY, AANCHAL (LGPC)
Entity type:Individual
Prefix:
First Name:AANCHAL
Middle Name:
Last Name:MOHANTY
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 1:110 W 39TH ST APT 1011
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-3135
Mailing Address - Country:US
Mailing Address - Phone:925-409-4038
Mailing Address - Fax:
Practice Address - Street 1:675 SEAWAVE CT
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2379
Practice Address - Country:US
Practice Address - Phone:410-604-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health