Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC9445 | MD |
NPI | 1003377094 |
---|---|
Provider Name | Gisele Ray Thompson |
First Address | Bel Air, MD 21014-5410 |
Second Address | Forest Hill, MD 21050-2631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2019 |
Last Update Date | 31/03/2019 |