Individual
IMANI A GAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADT
Contact information
Practice address
3310 EASTERN AVE, BALTIMORE, MD 21224-4108
(667) 239-7350
Mailing address
9808 BAYLINE CIR, OWINGS MILLS, MD 21117-5620
(410) 469-0568
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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