Healthcare Provider Details

I. General information

NPI: 1699591172
Provider Name (Legal Business Name): MMTHERAPY&CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 OXON HILL RD STE 200
FORT WASHINGTON MD
20744-4774
US

IV. Provider business mailing address

585 ARMISTICE BLVD
PAWTUCKET RI
02861-2648
US

V. Phone/Fax

Practice location:
  • Phone: 774-253-0104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARGARET FREMPONG
Title or Position: OWNER
Credential:
Phone: 774-253-0104