Provider Demographics
NPI:1720165574
Name:GAMBLE, LARRY ANTHONY (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ANTHONY
Last Name:GAMBLE
Suffix:
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 1:14127 YORKSHIRE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2872
Mailing Address - Country:US
Mailing Address - Phone:240-777-1444
Mailing Address - Fax:240-777-3381
Practice Address - Street 1:751 TWINBROOK PKWY STE 2
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1499
Practice Address - Country:US
Practice Address - Phone:240-281-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health