Healthcare Provider Details

I. General information

NPI: 1710270277
Provider Name (Legal Business Name): LISA MARIE HOWARD LICSW, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 GIBBS ST 473
ROCKVILLE MD
20850-0361
US

IV. Provider business mailing address

120 GIBBS STREET 473
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 602-460-2260
  • Fax:
Mailing address:
  • Phone: 602-460-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLASAC-13195
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number507588
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-12876
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079342
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: