Healthcare Provider Details

I. General information

NPI: 1548125834
Provider Name (Legal Business Name): NATALYA SACKS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12320 OLD CANAL RD
POTOMAC MD
20854-6238
US

IV. Provider business mailing address

12320 OLD CANAL RD
POTOMAC MD
20854-6238
US

V. Phone/Fax

Practice location:
  • Phone: 301-217-0855
  • Fax: 301-217-0855
Mailing address:
  • Phone: 301-217-0855
  • Fax: 301-217-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3280
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: