Individual
MICHAEL SOUTHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 N COURT ST, SUITE 203, FREDERICK, MD 21701-5416
(240) 409-4596
Mailing address
100 N COURT ST, SUITE 203, FREDERICK, MD 21701-5416
(240) 409-4596
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LGP5510
MD
101YP2500X
Professional Counselor
Primary
LC7423
MD
Other
Enumeration date
05/12/2014
Last updated
11/16/2016
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