Individual
IVALYNN GIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6100 RADIO STATION ROAD, LA PLATA, MD 20646
(310) 609-9887
(310) 609-9091
Mailing address
11707 MARSTON MOOR LANE, WALDORF, MD 20602
(310) 609-9887
(310) 609-9091
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/29/2008
Last updated
01/06/2015
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