Provider Demographics
NPI:1699444596
Name:VALLANDINGHAM, CHAD P (ADT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:P
Last Name:VALLANDINGHAM
Suffix:
Gender:M
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26845 POINT LOOKOUT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-4935
Mailing Address - Country:US
Mailing Address - Phone:240-309-4015
Mailing Address - Fax:
Practice Address - Street 1:26845 POINT LOOKOUT RD STE 1
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-4935
Practice Address - Country:US
Practice Address - Phone:240-309-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)