Individual
TEONNA L WALLOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1711 BRIGHTWELL CT, WALDORF, MD 20602-1634
(301) 850-1121
(301) 850-1121
Mailing address
1711 BRIGHTWELL CT, WALDORF, MD 20602-1634
(202) 580-9029
(301) 850-1121
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC4121
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D962945
—
MD
Enumeration date
09/18/2017
Last updated
09/18/2017
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