MEDICARE: GINA M. RASSA, LCPC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1215794003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINA M. RASSA, LCPC, INC.

Provider Business Mailing Address
First Line	:	7533 MAIN ST STE 1F
Second Line	:
City	:	SYKESVILLE
State	:	MD
Zip	:	21784-5308
Country	:	US
Telephone Number	:	410-970-6964
Fax Number	:	410-970-6157

Provider Business Practice Location Address
First Line	:	3450 ELLICOTT CENTER DR STE 205
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4667
Country	:	US
Telephone Number	:	410-970-6964
Fax Number	:	410-970-6157

Authorized Official
Title or Position	:	OWNER
Name	:	GINA MARIE RASSA
Credential	:	LCPC
Telephone Number	:	410-935-5140

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/28/2024

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