Healthcare Provider Details

I. General information

NPI: 1629730858
Provider Name (Legal Business Name): ANDY MORALES MS, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 WOODMONT AVE STE 840
BETHESDA MD
20814-2789
US

IV. Provider business mailing address

902 ALLAN RD
ROCKVILLE MD
20850-1422
US

V. Phone/Fax

Practice location:
  • Phone: 240-618-2889
  • Fax:
Mailing address:
  • Phone: 202-369-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11944
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11944
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: