Healthcare Provider Details

I. General information

NPI: 1396257887
Provider Name (Legal Business Name): DARBY INTEGRATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15932 SHADY GROVE RD UNIT B
GAITHERSBURG MD
20877-1314
US

IV. Provider business mailing address

9900 GEORGIA AVE APT 706
SILVER SPRING MD
20902-5243
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-8694
  • Fax:
Mailing address:
  • Phone: 301-960-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number19434
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number19434
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number19434
License Number StateMD

VIII. Authorized Official

Name: MR. ANDREW PAUL DARBY
Title or Position: CEO
Credential: LCSW-C
Phone: 301-960-8694