Healthcare Provider Details

I. General information

NPI: 1952870586
Provider Name (Legal Business Name): SONI NADINE FITZHUGH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 06/01/2021
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WAYNE AVE STE 204
SILVER SPRING MD
20910-4450
US

IV. Provider business mailing address

13605 ROBEY RD APT 206
SILVER SPRING MD
20904-4935
US

V. Phone/Fax

Practice location:
  • Phone: 301-804-3055
  • Fax:
Mailing address:
  • Phone: 301-704-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP9170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: