Healthcare Provider Details

I. General information

NPI: 1871113324
Provider Name (Legal Business Name): DIANA KOCHAN LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15235 SHADY GROVE RD STE 105
ROCKVILLE MD
20850-6278
US

IV. Provider business mailing address

12710 HELEN RD
SILVER SPRING MD
20906-4216
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-3030
  • Fax: 301-670-6767
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM420
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: