| Doctor Name: | CHRISTIE LYNN TANNER-GORMAN |
| NPI Number: | 1033113857 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 04158 |
| Business Practice Address: | 170 Thomas Johnson Dr Ste 200 Frederick, MD - 217026200 |
| Business Phone Number: | 3016958390 |
| Business Fax Number: | 3016947906 |
| Mailing Address: | 170 Thomas Johnson Dr, Ste 200 FREDERICK |
| State: | MD |
| Postal Code: | 217026200 |
| Phone Number: | 3016958390 |
| Fax Number: | 3016947906 |
| NPI Enumeration Date: | 06/09/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0000X |
| License Number: | 04158 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |