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General NPI Number Information
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NPI Number | 1457052136
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Entity Type | Organization
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Legal Business Name | DMV MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 316 MAIN ST STE 200
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City | GAITHERSBURG
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State | MD
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Zip | 20878-6551
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Country | US
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Telephone | 202-827-5830
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Fax | 240-630-1099
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Provider Business Mailing Address
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Address Line | 22520 SWEETLEAF LN
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City | GAITHERSBURG
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State | MD
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Zip | 20882-1450
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Country | US
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Telephone | 202-827-5830
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Fax | 240-630-1099
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Authorized Official
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Title or Position | OWNER
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Name | LAURA FUNKHOUSER
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Credential |
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Telephone | 202-827-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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