Provider Demographics
NPI:1295089142
Name:PENNINGTON, GINA FON (LCPC)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:FON
Last Name:PENNINGTON
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 1:839 BESTGATE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3472
Mailing Address - Country:US
Mailing Address - Phone:301-919-1158
Mailing Address - Fax:410-224-3711
Practice Address - Street 1:12331 QUIET OWL LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4308
Practice Address - Country:US
Practice Address - Phone:301-919-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health