Candace Domayer Ellrich, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC4025 Issued in MD

Practice address

10455 Falls Rd
Lutherville, MD 21093-3614

Phone

(410) 292-1115

NPI assigned

Jun 10, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Charm City Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lutherville, MD
  • NPI 1427640705

  Professional

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313539200000",
    "number": "1477848174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10455 FALLS RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210933614",
            "telephone_number": "410-292-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10455 FALLS RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210933614",
            "telephone_number": "410-292-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLRICH",
        "first_name": "CANDACE",
        "middle_name": "DOMAYER",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-10",
        "last_updated": "2011-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC4025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endodontics, P.a.

• Professional Counselor in Lutherville, MD
• Providers in Lutherville, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.