Provider Demographics
NPI:1376934299
Name:ROTHBAUM, GINA (COUNSELING RESIDENT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ROTHBAUM
Suffix:
Gender:F
Credentials:COUNSELING RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5431
Mailing Address - Country:US
Mailing Address - Phone:703-755-0848
Mailing Address - Fax:
Practice Address - Street 1:4601 FAIRFAX DR STE 1200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1559
Practice Address - Country:US
Practice Address - Phone:703-755-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor