Individual
SOPHIA LASIE GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1259 LIMIT AVE, BALTIMORE, MD 21239-1748
(443) 510-8226
Mailing address
1259 LIMIT AVE, BALTIMORE, MD 21239-1748
(443) 510-8226
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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