Provider Demographics
NPI:1447455373
Name:GALLAGHER, RITA S (LCPC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:S
Last Name:GALLAGHER
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 1:124 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5416
Mailing Address - Country:US
Mailing Address - Phone:301-668-1689
Mailing Address - Fax:301-668-1910
Practice Address - Street 1:124 N COURT ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5416
Practice Address - Country:US
Practice Address - Phone:301-668-1689
Practice Address - Fax:301-668-1910
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC0100OtherLICENSED CL PROF COUNSELO