Healthcare Provider Details

I. General information

NPI: 1972873669
Provider Name (Legal Business Name): NANCY LYNCH GIBSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 GORSUCH AVE
BALTIMORE MD
21218-3602
US

IV. Provider business mailing address

7822 CROSSBAY DR
SEVERN MD
21144-1631
US

V. Phone/Fax

Practice location:
  • Phone: 410-467-0675
  • Fax:
Mailing address:
  • Phone: 610-471-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4265
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: