Healthcare Provider Details

I. General information

NPI: 1053915892
Provider Name (Legal Business Name): CHRISTINE MURPHY LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST STE 328
SILVER SPRING MD
20910-3816
US

IV. Provider business mailing address

1800 WILSON BLVD UNIT 401
ARLINGTON VA
22201-6606
US

V. Phone/Fax

Practice location:
  • Phone: 617-922-3213
  • Fax:
Mailing address:
  • Phone: 617-922-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP10012
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: