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General NPI Number Information
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NPI Number | 1073867214
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Entity Type | Organization
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Legal Business Name | JESSICA GOTTLIEB LCPC, LLC
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 4400 E WEST HWY STE 720
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City | BETHESDA
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State | MD
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Zip | 20814-4509
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Country | US
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Telephone | 301-244-8257
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Fax |
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Provider Business Mailing Address
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Address Line | 4977 BATTERY LN APT 202
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City | BETHESDA
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State | MD
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Zip | 20814-4916
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Country | US
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Telephone | 301-502-6560
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JESSICA GOTTLIEB
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Credential | LCPC
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Telephone | 301-502-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC4324
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC4324
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC4324
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License Number State | MD
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