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General NPI Number Information
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NPI Number | 1023200227
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH CLINIC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 3601 CLARKS LN SUITE 5A
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City | BALTIMORE
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State | MD
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Zip | 21215-2731
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Country | US
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Telephone | 410-764-7777
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Fax | 410-764-7788
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Provider Business Mailing Address
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Address Line | 3601 CLARKS LN SUITE 5A
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City | BALTIMORE
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State | MD
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Zip | 21215-2731
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Country | US
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Telephone | 410-764-7777
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Fax | 410-764-7788
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. GABRIEL NEWMAN
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Credential | PHD
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Telephone | 410-764-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCM132
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LCM132
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License Number State | MD
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