Provider Demographics
NPI:1720132533
Name:RASSA, GINA MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:RASSA
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 1:7533 MAIN ST STE 1F
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5308
Mailing Address - Country:US
Mailing Address - Phone:410-935-5140
Mailing Address - Fax:410-970-6157
Practice Address - Street 1:7533 MAIN ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7374
Practice Address - Country:US
Practice Address - Phone:410-935-5140
Practice Address - Fax:410-970-6157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1765101YP2500X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist