Healthcare Provider Details

I. General information

NPI: 1255810057
Provider Name (Legal Business Name): THE SNOW PSYCHOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6274 MONTROSE RD
ROCKVILLE MD
20852-4119
US

IV. Provider business mailing address

812 KERSEY RD
SILVER SPRING MD
20902-3004
US

V. Phone/Fax

Practice location:
  • Phone: 240-676-4206
  • Fax:
Mailing address:
  • Phone: 240-676-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HOLLY SOISTMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 240-676-4206