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General NPI Number Information
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NPI Number | 1679599583
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Entity Type | Individual
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Provider Name | RISA LYNNE DAVIS-GANEL LCMFT
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3355 SAINT JOHNS LN SUITE F
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2605
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Country | US
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Telephone | 443-865-0298
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Fax |
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Provider Business Mailing Address
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Address Line | 6556 WALNUT GRV
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City | COLUMBIA
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State | MD
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Zip | 21044-4131
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Country | US
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Telephone | 443-865-0298
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LCM033
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License Number State | MD
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