Healthcare Provider Details

I. General information

NPI: 1720609795
Provider Name (Legal Business Name): AMBER MCCRADY TOELLER LCPC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 WOODMONT AVE STE 960
BETHESDA MD
20814-2775
US

IV. Provider business mailing address

15501 SCOTCH HEATHER CT
ROCKVILLE MD
20853-1491
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-3955
  • Fax:
Mailing address:
  • Phone: 301-466-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC14095
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC15337
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: