Healthcare Provider Details

I. General information

NPI: 1275198244
Provider Name (Legal Business Name): CYRUS DAVANI LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 DARNESTOWN RD STE 205
GAITHERSBURG MD
20878
US

IV. Provider business mailing address

10810 DARNESTOWN RD STE 205
GAITHERSBURG MD
20878
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-8120
  • Fax: 240-623-8120
Mailing address:
  • Phone: 301-714-8120
  • Fax: 240-623-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC9328
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9328
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: