Healthcare Provider Details

I. General information

NPI: 1083433510
Provider Name (Legal Business Name): VOLANTE WATERS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E DIAMOND AVE STE D
GAITHERSBURG MD
20877-5328
US

IV. Provider business mailing address

620 E DIAMOND AVE STE D
GAITHERSBURG MD
20877-5328
US

V. Phone/Fax

Practice location:
  • Phone: 443-960-6771
  • Fax:
Mailing address:
  • Phone: 443-960-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP12236
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: