MEDICARE: MRS. GRETA MICHELE MACGILL LCPC, RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC4122	MD

General Provider Information

NPI Number	:	1023443405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETA MICHELE MACGILL LCPC, RPT

Provider Business Mailing Address
First Line	:	5840 BANNEKER RD
Second Line	:	SUITE 270
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3103
Country	:	US
Telephone Number	:	410-730-2385
Fax Number	:

Provider Business Practice Location Address
First Line	:	5840 BANNEKER RD
Second Line	:	SUITE 270
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3103
Country	:	US
Telephone Number	:	410-730-2385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	12/16/2015

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