Healthcare Provider Details

I. General information

NPI: 1710714795
Provider Name (Legal Business Name): MICHAEL MCGILL JR. ED.S., N.C.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W MONTGOMERY AVE STE 300
ROCKVILLE MD
20850-4244
US

IV. Provider business mailing address

50 W MONTGOMERY AVE STE 300
ROCKVILLE MD
20850-4244
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: