Provider Demographics
NPI:1023443405
Name:MACGILL, GRETA MICHELE (LCPC, RPT)
Entity type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:MICHELE
Last Name:MACGILL
Suffix:
Gender:F
Credentials:LCPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 BANNEKER RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3103
Mailing Address - Country:US
Mailing Address - Phone:410-730-2385
Mailing Address - Fax:
Practice Address - Street 1:5840 BANNEKER RD
Practice Address - Street 2:SUITE 270
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3103
Practice Address - Country:US
Practice Address - Phone:410-730-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health