Healthcare Provider Details

I. General information

NPI: 1154216968
Provider Name (Legal Business Name): MC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4718
US

IV. Provider business mailing address

200 WASHINGTON AVE FL 5-NO18
TOWSON MD
21204-4718
US

V. Phone/Fax

Practice location:
  • Phone: 410-339-8269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE CHUNG
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential:
Phone: 410-267-3484