Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC11427 | MD |
NPI | 1003374752 |
---|---|
Provider Name | Nicholas A Etheridge |
First Address | Baltimore, MD 21214-2290 |
Second Address | Baltimore, MD 21214-2290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2019 |
Last Update Date | 24/05/2021 |