Healthcare Provider Details

I. General information

NPI: 1346162591
Provider Name (Legal Business Name): MISS HEATHER LEIGH GUSTAFSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 MACARTHUR BLVD STE 220
CABIN JOHN MD
20818-1634
US

IV. Provider business mailing address

7945 MACARTHUR BLVD STE 220
CABIN JOHN MD
20818-1634
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-0829
  • Fax:
Mailing address:
  • Phone: 301-618-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18221
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: