Healthcare Provider Details

I. General information

NPI: 1245191477
Provider Name (Legal Business Name): MICHELLE BAR-AV LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 EXECUTIVE PARK DRIVE SUITE 108
CATONSVILLE MD
21228
US

IV. Provider business mailing address

5470 EXECUTIVE PARK DRIVE SUITE 108
CATONSVILLE MD
21228
US

V. Phone/Fax

Practice location:
  • Phone: 443-228-6741
  • Fax:
Mailing address:
  • Phone: 443-228-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP17231
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: