Healthcare Provider Details

I. General information

NPI: 1023303476
Provider Name (Legal Business Name): LAURA CRUZ FAWZY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MARIE CRUZ MA, LGPC.

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E DIAMOND AVE STE 100A
GAITHERSBURG MD
20877-5321
US

IV. Provider business mailing address

1215 INGRAHAM ST NW
WASHINGTON DC
20011-3601
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3200
  • Fax: 301-840-1348
Mailing address:
  • Phone: 904-219-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP7068
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9361
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: