Healthcare Provider Details

I. General information

NPI: 1578253050
Provider Name (Legal Business Name): CHRISTEN YVETTE CONWAY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 01/13/2025
Certification Date: 12/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MERCANTILE LN STE 129-29
LARGO MD
20774-5327
US

IV. Provider business mailing address

PO BOX 82
BELTSVILLE MD
20704-0082
US

V. Phone/Fax

Practice location:
  • Phone: 301-684-6202
  • Fax:
Mailing address:
  • Phone: 202-288-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC15850
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC15850
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC15850
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: