Provider Demographics
NPI:1588744379
Name:GUBA, MARY MCMANUS (LCPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MCMANUS
Last Name:GUBA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPARKS FARM RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9300
Mailing Address - Country:US
Mailing Address - Phone:410-472-1434
Mailing Address - Fax:410-821-0790
Practice Address - Street 1:22 W PADONIA RD
Practice Address - Street 2:SUITE C-252
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-2226
Practice Address - Country:US
Practice Address - Phone:410-561-1114
Practice Address - Fax:410-821-0790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health