Healthcare Provider Details

I. General information

NPI: 1871728030
Provider Name (Legal Business Name): MRB COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E DIAMOND AVE SUITE C
GAITHERSBURG MD
20877-3093
US

IV. Provider business mailing address

317 E DIAMOND AVE SUITE C
GAITHERSBURG MD
20877-3093
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-0854
  • Fax: 240-243-1061
Mailing address:
  • Phone: 301-527-0854
  • Fax: 240-243-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA368
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1437
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number903540
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11362
License Number StateMD

VIII. Authorized Official

Name: DR. MARIA ROSA BUSTOS
Title or Position: PRESIDENT
Credential: PH.D
Phone: 301-512-0663