Healthcare Provider Details

I. General information

NPI: 1639948417
Provider Name (Legal Business Name): SUNDUS T AHMED LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 K ST NW
WASHINGTON DC
20005-2504
US

IV. Provider business mailing address

878 STEVENS ST
NORTH BRUNSWICK NJ
08902-2905
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-2722
  • Fax:
Mailing address:
  • Phone: 929-410-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704015483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: