Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LGP2948 | MD |
NPI | 1356615256 |
---|---|
Provider Name | Bridget Faraci |
First Address | Clarksburg, MD 20871-4505 |
Second Address | Clarksburg, MD 20871-4505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2012 |
Last Update Date | 24/02/2012 |