Healthcare Provider Details

I. General information

NPI: 1033600176
Provider Name (Legal Business Name): VALYNCIA N. GRAHAM, LLC DBA UNSTUCK COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 LAUREL PARK DR STE 116
LAUREL MD
20707-5203
US

IV. Provider business mailing address

14625 BALTIMORE AVE # 817
LAUREL MD
20707-4902
US

V. Phone/Fax

Practice location:
  • Phone: 240-804-8601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VALYNCIA N GRAHAM
Title or Position: OWNER
Credential:
Phone: 301-821-6507