Healthcare Provider Details

I. General information

NPI: 1710913488
Provider Name (Legal Business Name): DARWIN RAYMORE LCPC, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 NICHOLSON ST
NEW CARROLLTON MD
20784-2832
US

IV. Provider business mailing address

8500 NICHOLSON ST
NEW CARROLLTON MD
20784-2832
US

V. Phone/Fax

Practice location:
  • Phone: 301-452-2384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0685
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC936
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: