Healthcare Provider Details

I. General information

NPI: 1023443405
Provider Name (Legal Business Name): GRETA MICHELE MACGILL LCPC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5840 BANNEKER RD SUITE 270
COLUMBIA MD
21044-3103
US

IV. Provider business mailing address

5840 BANNEKER RD SUITE 270
COLUMBIA MD
21044-3103
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax:
Mailing address:
  • Phone: 410-730-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC4122
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: