MEDICARE: GIFT OF LIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1164350617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFT OF LIFE

Provider Business Mailing Address
First Line	:	15107 INTERLACHEN DR # 2-703
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-5625
Country	:	US
Telephone Number	:	410-978-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	15107 INTERLACHEN DR # 2-703
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-5625
Country	:	US
Telephone Number	:	410-978-0001
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	MS. NEZHLA BOZORGMAND MOMAYEZI II
Credential	:	LCPC
Telephone Number	:	410-978-0001

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “GIFT OF LIFE ” Practice Location

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