Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LGP6742 | MD |
Y | 101YP2500X | Professional Counselor | LC7930 | MD |
NPI | 1003359332 |
---|---|
Provider Name | Ms. Hannah Elise Rose |
First Address | Baltimore, MD 21211 |
Second Address | Baltimore, MD 21211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2016 |
Last Update Date | 18/06/2019 |