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General NPI Number Information
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NPI Number | 1114766318
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Entity Type | Individual
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Provider Name | GABRIELLE BROOKE LYONS LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 29466 PINTAIL DR STE 4
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City | EASTON
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State | MD
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Zip | 21601-9324
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Country | US
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Telephone | 443-528-5067
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Fax |
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Provider Business Mailing Address
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Address Line | 1056 BROAD LEAF CT
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City | TRAPPE
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State | MD
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Zip | 21673-1578
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Country | US
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Telephone | 410-924-3359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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