Healthcare Provider Details

I. General information

NPI: 1215048962
Provider Name (Legal Business Name): JOHN WALLS GANO MS, NCC, LPCMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WALKER RD
DOVER DE
19904-2768
US

IV. Provider business mailing address

302 ELKTON BLVD
ELKTON MD
21921-5419
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2380
  • Fax: 302-674-1299
Mailing address:
  • Phone: 410-620-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000328
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: