MEDICARE: LATASHA BRANCH 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	101YP2500X	Professional Counselor	LGP8707	MD
2	101YP2500X	Professional Counselor	LC10477	MD

General Provider Information

NPI Number	:	1598259327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA BRANCH LGPC

Provider Business Mailing Address
First Line	:	7474 GREENWAY CENTER DR STE 730
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3523
Country	:	US
Telephone Number	:	301-345-1022
Fax Number	:	301-560-5558

Provider Business Practice Location Address
First Line	:	1707 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4135
Country	:	US
Telephone Number	:	240-347-2581
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	05/17/2021

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Directions to “ LATASHA BRANCH LGPC” Practice Location

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