Healthcare Provider Details

I. General information

NPI: 1942629761
Provider Name (Legal Business Name): MARY WITTERIED LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PICCARD DR
ROCKVILLE MD
20850-4320
US

IV. Provider business mailing address

1301 PICCARD DR
ROCKVILLE MD
20850-4320
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-4545
  • Fax: 240-777-4800
Mailing address:
  • Phone: 240-777-4545
  • Fax: 240-777-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2080
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: