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General NPI Number Information
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NPI Number | 1154693588
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Entity Type | Organization
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Legal Business Name | LIFE QUALITY PSYCHIATRIC MULTI DISCIPLINARY GROUP, LLC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 604 S FREDERICK AVE SUITE 211
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1275
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Country | US
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Telephone | 301-330-6470
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Fax | 301-330-6472
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Provider Business Mailing Address
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Address Line | 604 S FREDERICK AVE SUITE 211
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1275
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Country | US
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Telephone | 301-330-6470
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Fax | 301-330-6472
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Authorized Official
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Title or Position | OWNER -MANAGER
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Name | MS. MONA ATTIA
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Credential |
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Telephone | 301-330-6470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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