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General NPI Number Information
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NPI Number | 1417410044
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Entity Type | Organization
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Legal Business Name | DXT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 7610 PENNSYLVANIA AVE STE 301
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-4701
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Country | US
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Telephone | 240-676-2895
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Fax | 240-838-7736
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Provider Business Mailing Address
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Address Line | 3314 VALLEY FOREST DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-9400
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Country | US
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Telephone | 240-676-2895
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MICHELLE HARE
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Credential | LCPC,LPC,MAC
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Telephone | 240-676-2895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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