Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LGP5714 | MD |
NPI | 1003222175 |
---|---|
Provider Name | Lynette Brooks Taylor |
First Address | District Heights, MD 20747-2968 |
Second Address | District Heights, MD 20747-2968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 09/07/2014 |