Healthcare Provider Details

I. General information

NPI: 1417602012
Provider Name (Legal Business Name): STEPHANIE HOLLAND LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17904 GEORGIA AVE STE 200
OLNEY MD
20832-2277
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 200
GREENBELT MD
20770-3524
US

V. Phone/Fax

Practice location:
  • Phone: 240-304-3327
  • Fax:
Mailing address:
  • Phone: 240-304-3327
  • Fax: 410-609-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP12406
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: