Healthcare Provider Details

I. General information

NPI: 1164389003
Provider Name (Legal Business Name): GLENDA MARIE AUGUSTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15204 OMEGA DR STE 100
ROCKVILLE MD
20850-4812
US

IV. Provider business mailing address

7 NOCTURNE CT
ROCKVILLE MD
20850-2852
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-6750
  • Fax:
Mailing address:
  • Phone: 301-442-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33989
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33989
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: