Individual
ETHLYNNE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
(443) 444-3812
Mailing address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
17105
MD
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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