Healthcare Provider Details

I. General information

NPI: 1164350617
Provider Name (Legal Business Name): GIFT OF LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 INTERLACHEN DR # 2-703
SILVER SPRING MD
20906-5625
US

IV. Provider business mailing address

15107 INTERLACHEN DR # 2-703
SILVER SPRING MD
20906-5625
US

V. Phone/Fax

Practice location:
  • Phone: 410-978-0001
  • Fax:
Mailing address:
  • Phone: 410-978-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. NEZHLA BOZORGMAND MOMAYEZI II
Title or Position: PROVIDER
Credential: LCPC
Phone: 410-978-0001