Healthcare Provider Details

I. General information

NPI: 1356700470
Provider Name (Legal Business Name): PEGGY MONTGOMERY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 HICKORY RIDGE RD STE 113
COLUMBIA MD
21044-3681
US

IV. Provider business mailing address

10750 HICKORY RIDGE RD STE 113
COLUMBIA MD
21044-3681
US

V. Phone/Fax

Practice location:
  • Phone: 443-621-0583
  • Fax:
Mailing address:
  • Phone: 443-621-0583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number06177
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: