Healthcare Provider Details

I. General information

NPI: 1295365260
Provider Name (Legal Business Name): MMC PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2020
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 GEORGIA AVE STE 712
SILVER SPRING MD
20910-3439
US

IV. Provider business mailing address

8601 GEORGIA AVE STE 712
SILVER SPRING MD
20910-3439
US

V. Phone/Fax

Practice location:
  • Phone: 202-505-1848
  • Fax: 240-788-6198
Mailing address:
  • Phone: 202-505-1848
  • Fax: 240-788-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL MORAD-MCCOY
Title or Position: CLINICAL DIRECTOR
Credential: PH.D., LPCC
Phone: 202-505-1848