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General NPI Number Information
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NPI Number | 1538625108
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Entity Type | Individual
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Provider Name | JOHN C. GAITHER LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 200 E NORTH AVE
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City | BALTIMORE
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State | MD
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Zip | 21202-4888
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Country | US
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Telephone | 443-642-4205
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Fax |
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Provider Business Mailing Address
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Address Line | 2707 CHESWOLDE RD
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City | BALTIMORE
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State | MD
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Zip | 21209-3928
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Country | US
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Telephone | 443-560-3054
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13081
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License Number State | MD
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