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General NPI Number Information
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NPI Number | 1295909307
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Entity Type | Organization
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Legal Business Name | GAIA HOLISTIC COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 134 BALTIMORE ST
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City | CUMBERLAND
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State | MD
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Zip | 21502
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Country | US
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Telephone | 301-777-0620
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Fax | 301-777-2906
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Provider Business Mailing Address
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Address Line | 134 BALTIMORE ST
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City | CUMBERLAND
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State | MD
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Zip | 21502
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Country | US
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Telephone | 301-777-0620
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Fax | 301-777-2906
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROBERT LYNN LYNN
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Credential | MD
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Telephone | 301-777-0620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 13631
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC1720
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License Number State | MD
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