Healthcare Provider Details

I. General information

NPI: 1093623563
Provider Name (Legal Business Name): STEPHANIE KING DESMOND LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W PATRICK ST STE 320
FREDERICK MD
21701-5655
US

IV. Provider business mailing address

27915 BARNES RD
DAMASCUS MD
20872-1534
US

V. Phone/Fax

Practice location:
  • Phone: 240-792-8404
  • Fax:
Mailing address:
  • Phone: 301-996-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18431
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: