Provider Demographics
NPI:1174867303
Name:GOGOLINSKI, TARA (MS, LCMFT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GOGOLINSKI
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 CROFTON LN STE 11
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2431 CROFTON LN
Practice Address - Street 2:SUITE 11
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1327
Practice Address - Country:US
Practice Address - Phone:410-793-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist