Healthcare Provider Details

I. General information

NPI: 1821916628
Provider Name (Legal Business Name): DAVID HUSCHAM JEAN-JULIEN LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 KNOX RD STE 201
COLLEGE PARK MD
20740-3380
US

IV. Provider business mailing address

4511 KNOX RD STE 201
COLLEGE PARK MD
20740-3380
US

V. Phone/Fax

Practice location:
  • Phone: 240-582-7513
  • Fax:
Mailing address:
  • Phone: 240-582-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17778
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: