MEDICARE: GILEAD CHRISTIAN COUNSELING LLC

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	1041C0700X	Clinical Social Worker	14689	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982089637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILEAD CHRISTIAN COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 282
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-0282
Country	:	US
Telephone Number	:	443-404-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 CALVERT BEACH RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-2843
Country	:	US
Telephone Number	:	443-404-7366
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LINDA ANNE WILBANKS
Credential	:	LCSW-C
Telephone Number	:	443-404-7366

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	07/23/2015

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