Provider Demographics
NPI:1801456934
Name:AICHENBAUM, TOVA (LGPC)
Entity type:Individual
Prefix:
First Name:TOVA
Middle Name:
Last Name:AICHENBAUM
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 W STRATHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3716
Mailing Address - Country:US
Mailing Address - Phone:410-240-2883
Mailing Address - Fax:
Practice Address - Street 1:4012 FALLSTAFF RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1406
Practice Address - Country:US
Practice Address - Phone:410-240-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional