Provider Demographics
NPI:1255879714
Name:FOARD, MARY BRANCH (MS, MA, LGPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BRANCH
Last Name:FOARD
Suffix:
Gender:F
Credentials:MS, MA, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:228 AMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1220
Mailing Address - Country:US
Mailing Address - Phone:410-627-3859
Mailing Address - Fax:410-987-4710
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2639
Practice Address - Country:US
Practice Address - Phone:410-627-3859
Practice Address - Fax:410-987-4710
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional