MEDICARE: DONNA MARIE STOUT LCPC

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	LC1886	MD

General Provider Information

NPI Number	:	1205995859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MARIE STOUT LCPC

Provider Business Mailing Address
First Line	:	7915 KNOLLWOOD RD APT C
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-1256
Country	:	US
Telephone Number	:	410-321-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W BEL AIR AVE
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-3221
Country	:	US
Telephone Number	:	410-297-2271
Fax Number	:	410-297-2273

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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Directions to “ DONNA MARIE STOUT LCPC” Practice Location

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