Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC6145 | MD |
NPI | 1003298845 |
---|---|
Provider Name | Mrs. Lara Jayne Peter |
First Address | Columbia, MD 21044-4404 |
Second Address | Columbia, MD 21044-6278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2015 |
Last Update Date | 19/08/2021 |