Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LGPC #147 | MD |
NPI | 1285681817 |
---|---|
Provider Name | Mrs. Olga Louise Booth |
First Address | Huntingtown, MD 20639-9586 |
Second Address | Parkville, MD 21234-5888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 08/07/2007 |