Healthcare Provider Details

I. General information

NPI: 1982195731
Provider Name (Legal Business Name): CAPITAL CONNECTIONS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 05/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 HUNGERFORD DR # 7A
ROCKVILLE MD
20850-1714
US

IV. Provider business mailing address

966 HUNGERFORD DR # 7A
ROCKVILLE MD
20850-1714
US

V. Phone/Fax

Practice location:
  • Phone: 301-971-2950
  • Fax:
Mailing address:
  • Phone: 301-971-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HAST
Title or Position: THERAPIST
Credential: LCPC, NCC
Phone: 301-971-2950