Healthcare Provider Details

I. General information

NPI: 1710530936
Provider Name (Legal Business Name): RICHARD THOMAS CONWAY JR. LCPAT LCPC, ATR-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICK CONWAY LCPAT, LCPC, ATR-BC

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SEVEN LOCKS RD STE 360
POTOMAC MD
20854-6901
US

IV. Provider business mailing address

13201 VALLEY BRIDGE CT
SILVER SPRING MD
20906-5824
US

V. Phone/Fax

Practice location:
  • Phone: 240-293-0022
  • Fax: 240-597-3079
Mailing address:
  • Phone: 240-293-0022
  • Fax: 240-597-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCP11125
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATC280
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: