Healthcare Provider Details

I. General information

NPI: 1598058034
Provider Name (Legal Business Name): JOSEPHINE DYKES STATON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20411 LINDOS CT N/A
MONTGOMERY VILLAGE MD
20886-4367
US

IV. Provider business mailing address

20411 LINDOS CT N/A
MONTGOMERY VILLAGE MD
20886-4367
US

V. Phone/Fax

Practice location:
  • Phone: 202-581-2445
  • Fax: 202-581-2459
Mailing address:
  • Phone: 202-581-2445
  • Fax: 202-581-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC236
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: