Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC2237 | MD |
NPI | 1003909342 |
---|---|
Provider Name | Ms. Cynthia Ann Green |
First Address | Frederick, MD 21701-4816 |
Second Address | Frederick, MD 21701-5514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2006 |
Last Update Date | 18/09/2007 |