Active NPI
Champ Moultrie
- Professional Counselor
- Laurel, MD
National Provider Identifier
1699437822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LGP10255
- Practice address
- 9660 Iron Leaf TRL
Laurel, MD 20723-5878 - Phone
- (443) 687-6827
- NPI assigned
- Oct 5, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LGP10255 | MD | Primary |
Addresses
Primary practice location
9660 Iron Leaf TRL
Laurel, MD 20723-5878
Mailing address
7914 Bentbough Rd
Severn, MD 21144-1077
Phone (443) 687-6827
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP10255 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633392000000",
"number": "1699437822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7914 BENTBOUGH RD",
"city": "SEVERN",
"state": "MD",
"postal_code": "211441077",
"telephone_number": "443-687-6827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9660 IRON LEAF TRL",
"city": "LAUREL",
"state": "MD",
"postal_code": "207235878",
"telephone_number": "443-687-6827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTRIE",
"first_name": "CHAMP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-05",
"last_updated": "2021-10-05",
"certification_date": "2021-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LGP10255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.