Healthcare Provider Details

I. General information

NPI: 1083321574
Provider Name (Legal Business Name): LYNEETA GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17530 LAKE MELFORD AVE APT 1079
BOWIE MD
20715-4511
US

IV. Provider business mailing address

17530 LAKE MELFORD AVE APT 1079
BOWIE MD
20715-4511
US

V. Phone/Fax

Practice location:
  • Phone: 301-395-4780
  • Fax:
Mailing address:
  • Phone: 301-395-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: