Healthcare Provider Details

I. General information

NPI: 1902761273
Provider Name (Legal Business Name): CHICKPEA COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 WISCONSIN AVE STE 204
CHEVY CHASE MD
20815-3524
US

IV. Provider business mailing address

5480 WISCONSIN AVE STE 204
CHEVY CHASE MD
20815-3524
US

V. Phone/Fax

Practice location:
  • Phone: 240-377-4653
  • Fax: 240-377-4654
Mailing address:
  • Phone: 240-377-4653
  • Fax: 240-377-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRANDON LOPEZ
Title or Position: OWNER
Credential:
Phone: 860-878-9702