MEDICARE: DANIEL DEBOLD LCPC

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	101Y00000X	Counselor	LC0116	MD

General Provider Information

NPI Number	:	1649203852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DEBOLD LCPC

Provider Business Mailing Address
First Line	:	7827 WISE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-3339
Country	:	US
Telephone Number	:	410-282-7222
Fax Number	:	410-282-0069

Provider Business Practice Location Address
First Line	:	7827 WISE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-3339
Country	:	US
Telephone Number	:	410-282-7222
Fax Number	:	410-282-0069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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