Provider Demographics
NPI:1437461308
Name:CONDON, GWEN MARIE (MS, LCPC)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:MARIE
Last Name:CONDON
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LEEWARD CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3489
Mailing Address - Country:US
Mailing Address - Phone:410-703-4388
Mailing Address - Fax:888-365-4711
Practice Address - Street 1:8 LEEWARD CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3489
Practice Address - Country:US
Practice Address - Phone:410-703-4388
Practice Address - Fax:888-365-4711
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional