Healthcare Provider Details

I. General information

NPI: 1669922340
Provider Name (Legal Business Name): MARTHA KENT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8357 TAMAR DR
COLUMBIA MD
21045-5703
US

IV. Provider business mailing address

12530 FAIRWOOD PKWY STE 102
BOWIE MD
20720-6357
US

V. Phone/Fax

Practice location:
  • Phone: 202-215-4917
  • Fax:
Mailing address:
  • Phone: 202-215-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC9990
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: