Healthcare Provider Details

I. General information

NPI: 1699013912
Provider Name (Legal Business Name): AMIE KOTZ LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 ROCKVILLE PIKE STE 306
ROCKVILLE MD
20852-3142
US

IV. Provider business mailing address

11125 ROCKVILLE PIKE STE 302
ROCKVILLE MD
20852-3142
US

V. Phone/Fax

Practice location:
  • Phone: 240-242-4225
  • Fax:
Mailing address:
  • Phone: 240-242-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC11290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: