Healthcare Provider Details

I. General information

NPI: 1043594310
Provider Name (Legal Business Name): KATHY WU LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17826 NEW HAMPSHIRE AVE
ASHTON MD
20861-9781
US

IV. Provider business mailing address

202 EVANS ST
ROCKVILLE MD
20850-2820
US

V. Phone/Fax

Practice location:
  • Phone: 180-049-1536
  • Fax:
Mailing address:
  • Phone: 301-750-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: