Healthcare Provider Details

I. General information

NPI: 1285380121
Provider Name (Legal Business Name): MICHAEL BARNETTE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9606 SPIRITUAL LN
UPPER MARLBORO MD
20774-9319
US

IV. Provider business mailing address

9606 SPIRITUAL LN
UPPER MARLBORO MD
20774-9319
US

V. Phone/Fax

Practice location:
  • Phone: 202-599-5415
  • Fax:
Mailing address:
  • Phone: 202-599-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC15019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: