Healthcare Provider Details

I. General information

NPI: 1073279220
Provider Name (Legal Business Name): WELLPATH COUNSELING AND CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 WISCONSIN AVE STE 1140
BETHESDA MD
20815-6105
US

IV. Provider business mailing address

7512 INDIAN HILLS DR
DERWOOD MD
20855-2619
US

V. Phone/Fax

Practice location:
  • Phone: 240-813-3935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MINDY NAVARRO
Title or Position: LCPC
Credential: LCPC
Phone: 240-813-3935