Healthcare Provider Details

I. General information

NPI: 1992323273
Provider Name (Legal Business Name): CASSANDRA EDWARDS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10411 MOTOR CITY DR
BETHESDA MD
20817-1008
US

IV. Provider business mailing address

230 SPECTRUM AVE APT 436
GAITHERSBURG MD
20879-3486
US

V. Phone/Fax

Practice location:
  • Phone: 703-552-2722
  • Fax: 703-564-8567
Mailing address:
  • Phone: 301-828-5999
  • Fax: 703-564-8567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP9368
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: