Provider Demographics
NPI:1760105365
Name:GANN, DONALD S JR (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:GANN
Suffix:JR
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAMILL RD STE 332
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1813
Mailing Address - Country:US
Mailing Address - Phone:443-266-2270
Mailing Address - Fax:888-835-6363
Practice Address - Street 1:2 HAMILL RD STE 332
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1813
Practice Address - Country:US
Practice Address - Phone:443-266-2270
Practice Address - Fax:888-835-6363
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical