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General NPI Number Information
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NPI Number | 1245966951
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Entity Type | Organization
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Legal Business Name | MINDSPACE CLINICAL COUNSELING LLC
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 12345 PARKLAWN DR STE 200
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City | ROCKVILLE
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State | MD
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Zip | 20852-1725
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Country | US
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Telephone | 240-394-6530
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Fax |
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Provider Business Mailing Address
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Address Line | 9711 WASHINGTONIAN BLVD STE 550
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5789
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Country | US
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Telephone | 202-487-3813
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | ESTHER H KIM
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Credential | LCSW-C
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Telephone | 240-394-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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