Healthcare Provider Details

I. General information

NPI: 1336954684
Provider Name (Legal Business Name): CAPITAL CHILDREN'S WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8618 WILD OLIVE DR
POTOMAC MD
20854-3438
US

IV. Provider business mailing address

8618 WILD OLIVE DR
POTOMAC MD
20854-3438
US

V. Phone/Fax

Practice location:
  • Phone: 202-374-6717
  • Fax:
Mailing address:
  • Phone: 202-374-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MAIZEL
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: MA, LCPC, RPT
Phone: 202-374-6717