Healthcare Provider Details

I. General information

NPI: 1295909307
Provider Name (Legal Business Name): GAIA HOLISTIC COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 BALTIMORE ST
CUMBERLAND MD
21502
US

IV. Provider business mailing address

134 BALTIMORE ST
CUMBERLAND MD
21502
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-0620
  • Fax: 301-777-2906
Mailing address:
  • Phone: 301-777-0620
  • Fax: 301-777-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC1720
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13631
License Number StateMD

VIII. Authorized Official

Name: DR. ROBERT LYNN LYNN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 301-777-0620