Healthcare Provider Details

I. General information

NPI: 1548024441
Provider Name (Legal Business Name): ONDREJ SROBA LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 LORAIN AVE
SILVER SPRING MD
20901-3251
US

IV. Provider business mailing address

9707 LORAIN AVE
SILVER SPRING MD
20901-3251
US

V. Phone/Fax

Practice location:
  • Phone: 301-263-4572
  • Fax:
Mailing address:
  • Phone: 301-263-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: