Healthcare Provider Details

I. General information

NPI: 1083005870
Provider Name (Legal Business Name): THE COUNSELING CENTER OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 WOODMONT AVENUE 3RD FLOOR
BETHESDA MD
20814
US

IV. Provider business mailing address

8030 WOODMONT AVENUE 3RD FLOOR
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-742-2282
  • Fax: 301-802-2146
Mailing address:
  • Phone: 301-742-2282
  • Fax: 301-802-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6929
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARJONE LAUREN KREPPEL
Title or Position: FOUNDER/DIRECTOR
Credential: LCPC
Phone: 301-651-0303