Healthcare Provider Details

I. General information

NPI: 1245055276
Provider Name (Legal Business Name): VIVIANA AZAR LCMFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 GEORGIA AVE STE 205
SILVER SPRING MD
20910-3614
US

IV. Provider business mailing address

9200 WENDELL ST
SILVER SPRING MD
20901-3532
US

V. Phone/Fax

Practice location:
  • Phone: 301-642-2793
  • Fax:
Mailing address:
  • Phone: 301-642-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. VIVIANA AZAR
Title or Position: OWNER
Credential: LCMFT
Phone: 301-642-2793