MEDICARE: STEPHANIE C WINGER RODRIGUEZ LGPC

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	101YM0800X	Mental Health Counselor	LGP9371	MD

General Provider Information

NPI Number	:	1518426105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE C WINGER RODRIGUEZ LGPC

Provider Business Mailing Address
First Line	:	14228 CHADWICK LN
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20853-2106
Country	:	US
Telephone Number	:	571-970-8246
Fax Number	:

Provider Business Practice Location Address
First Line	:	8730 GEORGIA AVE STE 200B
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3604
Country	:	US
Telephone Number	:	301-960-8694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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