Provider Demographics
NPI:1457241499
Name:CHAMAMA, GILA (LGPC)
Entity type:Individual
Prefix:
First Name:GILA
Middle Name:
Last Name:CHAMAMA
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 1:1600 CRAIN HWY S STE 608
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6442
Mailing Address - Country:US
Mailing Address - Phone:443-354-1200
Mailing Address - Fax:410-553-0019
Practice Address - Street 1:1600 CRAIN HWY S STE 608
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6442
Practice Address - Country:US
Practice Address - Phone:443-354-1200
Practice Address - Fax:410-553-0019
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16444103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling