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General NPI Number Information
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NPI Number | 1982089637
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Entity Type | Organization
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Legal Business Name | GILEAD CHRISTIAN COUNSELING LLC
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 950 CALVERT BEACH RD
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City | SAINT LEONARD
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State | MD
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Zip | 20685-2843
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Country | US
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Telephone | 443-404-7366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 282
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-0282
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Country | US
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Telephone | 443-404-7366
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LINDA ANNE WILBANKS
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Credential | LCSW-C
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Telephone | 443-404-7366
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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 | 14689
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License Number State | MD
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