Healthcare Provider Details

I. General information

NPI: 1013242759
Provider Name (Legal Business Name): DENINE MARIA GUDNITZ LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST LOWER LEVEL
GAITHERSBURG MD
20878-6521
US

IV. Provider business mailing address

12060 LITTLE PATUXENT PKWY APT C
COLUMBIA MD
21044-4825
US

V. Phone/Fax

Practice location:
  • Phone: 301-512-9922
  • Fax:
Mailing address:
  • Phone: 301-512-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3277
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: