Provider Demographics
NPI:1346810959
Name:GAITHER, JEANETTE JOHNSON (LCPC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:JOHNSON
Last Name:GAITHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5037
Mailing Address - Country:US
Mailing Address - Phone:410-805-2362
Mailing Address - Fax:
Practice Address - Street 1:5927 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5037
Practice Address - Country:US
Practice Address - Phone:410-805-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional