Healthcare Provider Details

I. General information

NPI: 1851602809
Provider Name (Legal Business Name): FAMILY ADVOCACY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 MARTIN LUTHER KING JR HWY SUITE 4
LANHAM MD
20706-1500
US

IV. Provider business mailing address

8601 MARTIN LUTHER KING JR HWY SUITE 4
LANHAM MD
20706-1500
US

V. Phone/Fax

Practice location:
  • Phone: 301-322-1238
  • Fax: 301-322-1239
Mailing address:
  • Phone: 301-322-1238
  • Fax: 301-322-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC350
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01027
License Number StateMD

VIII. Authorized Official

Name: MS. LINDA MARIE CARTER
Title or Position: CEO/PRESIDENT
Credential: MA, LPC
Phone: 301-322-1238