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Individual

MRS. TARA PISTORIO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCPC, CAC-AD

Contact information

Practice address
8600 LASALLE RD., CARROLL BUILDING, SUITE 212, TOWSON, MD 21286-2128
(410) 773-0500
Mailing address
4 BRAMBLE LN, CHURCHVILLE, MD 21028-1505
(410) 207-2509

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
AC1649
MD
101YM0800X
Mental Health Counselor
Primary
LC9296
MD

Other

Enumeration date
12/04/2020
Last updated
12/04/2020
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