Provider Demographics
NPI:1700265055
Name:GINA M. RASSA, LCPC, INC.
Entity Type:Organization
Organization Name:GINA M. RASSA, LCPC, INC.
Other - Org Name:THE COUNSELING RENAISSANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RASSA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-935-5140
Mailing Address - Street 1:7533 MAIN ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7374
Mailing Address - Country:US
Mailing Address - Phone:410-970-6964
Mailing Address - Fax:410-970-6157
Practice Address - Street 1:263 W PATRICK ST
Practice Address - Street 2:RM 1
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6910
Practice Address - Country:US
Practice Address - Phone:410-970-6964
Practice Address - Fax:410-970-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1765101YP2500X
MD120851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty