Provider Demographics
NPI:1114035680
Name:GACH, JIM EARL (LCSWC)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:EARL
Last Name:GACH
Suffix:
Gender:M
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PROVIDENCE RD
Mailing Address - Street 2:THE COUNSELING CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5503
Mailing Address - Country:US
Mailing Address - Phone:410-583-7443
Mailing Address - Fax:410-583-0711
Practice Address - Street 1:600 PROVIDENCE RD
Practice Address - Street 2:THE COUNSELING CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-5503
Practice Address - Country:US
Practice Address - Phone:410-583-7443
Practice Address - Fax:410-583-0711
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD036571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
52893701OtherBCBS
52893701OtherBCBS
MD1689897928Medicare PIN