Healthcare Provider Details

I. General information

NPI: 1750815999
Provider Name (Legal Business Name): VAKEEMA ENSLEY-CREWS LGPC,LGADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 BEL PRE DR
SILVER SPRING MD
20906-2250
US

IV. Provider business mailing address

14402 BEL PRE DR
SILVER SPRING MD
20906-2250
US

V. Phone/Fax

Practice location:
  • Phone: 240-630-4334
  • Fax:
Mailing address:
  • Phone: 240-630-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP7206
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLGA2186
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: