Provider Demographics
NPI:1801688247
Name:CHALL, STEPHANIE (LGPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHALL
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 1:1415 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1924
Mailing Address - Country:US
Mailing Address - Phone:732-713-9065
Mailing Address - Fax:
Practice Address - Street 1:588 BELLERIVE DR STE 1D
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4639
Practice Address - Country:US
Practice Address - Phone:443-949-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional