Healthcare Provider Details

I. General information

NPI: 1740045731
Provider Name (Legal Business Name): SAVANNAH MAASS LGPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

1235 10TH ST NW LOWR UNIT
WASHINGTON DC
20001-6342
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-8196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200001688
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: