Healthcare Provider Details

I. General information

NPI: 1912831926
Provider Name (Legal Business Name): SIDE QUEST PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 BALTIMORE AVE STE 109
COLLEGE PARK MD
20740-3231
US

IV. Provider business mailing address

7307 BALTIMORE AVE STE 109
COLLEGE PARK MD
20740-3231
US

V. Phone/Fax

Practice location:
  • Phone: 443-741-1598
  • Fax:
Mailing address:
  • Phone: 240-854-7887
  • Fax:

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: JENNA STONE
Title or Position: CLINICAL DIRECTOR
Credential: LCSW-C
Phone: 443-741-1598