Healthcare Provider Details

I. General information

NPI: 1710451174
Provider Name (Legal Business Name): HEURISTIC THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19707 EXECUTIVE PARK CIR
GERMANTOWN MD
20874-2639
US

IV. Provider business mailing address

19707 EXECUTIVE PARK CIRCLE
GERMANTOWN MD
20874
US

V. Phone/Fax

Practice location:
  • Phone: 301-250-9965
  • Fax: 240-306-1104
Mailing address:
  • Phone: 301-250-9965
  • Fax: 240-306-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SONALI G SHARMA
Title or Position: CEO/OWNER
Credential: LCPC-S
Phone: 301-250-9965