Healthcare Provider Details

I. General information

NPI: 1629478045
Provider Name (Legal Business Name): CENTER FOR HOLISTIC MENTAL HEALTH AND SEXUAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1003 SPRING ST
SILVER SPRING MD
20910
US

IV. Provider business mailing address

7604 ELIOAKTER
GAITHERSBURG MD
20879
US

V. Phone/Fax

Practice location:
  • Phone: 240-449-4347
  • Fax:
Mailing address:
  • Phone: 240-449-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC5248
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DAVID ALAN FISHMAN
Title or Position: CEO
Credential: LCPC
Phone: 240-449-4347