Provider Demographics
NPI:1174759450
Name:MARTH, THERESA L (LCPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:MARTH
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 1:134 BALTIMORE ST
Mailing Address - Street 2:GAIA HOLISTIC COUNSELING SERVICES, LLC
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2302
Mailing Address - Country:US
Mailing Address - Phone:301-777-0620
Mailing Address - Fax:301-777-2906
Practice Address - Street 1:134 BALTIMORE ST
Practice Address - Street 2:GAIA HOLISTIC COUNSELING SERVICES, LLC
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2302
Practice Address - Country:US
Practice Address - Phone:301-777-0620
Practice Address - Fax:301-777-2906
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional