Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LC3573 | MD |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LC3573 | MD |
Y | 101YM0800X | Mental Health Counselor | LC3573 | MD |
N | 101YP1600X | Pastoral Counselor | LC3573 | MD |
N | 101YP2500X | Professional Counselor | LC3573 | MD |
NPI | 1356644116 |
---|---|
Provider Name | Mrs. Brenda Dorsch Ibutu |
First Address | Lansdowne, MD 21227-2249 |
Second Address | Lansdowne, MD 21227-2249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2010 |
Last Update Date | 15/12/2010 |