Provider Demographics
NPI:1972873669
Name:GIBSON, NANCY LYNCH (LCPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNCH
Last Name:GIBSON
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 1:7822 CROSSBAY DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1631
Mailing Address - Country:US
Mailing Address - Phone:610-471-4076
Mailing Address - Fax:
Practice Address - Street 1:949 GORSUCH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3602
Practice Address - Country:US
Practice Address - Phone:410-467-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional