Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC1197 | MD |
NPI | 1003321548 |
---|---|
Provider Name | Melissa A Doan |
First Address | Owings Mills, MD 21117-5603 |
Second Address | Westminster, MD 21157-5838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2017 |
Last Update Date | 06/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LC1197 | STATE LICENSE (01) | MD |