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General NPI Number Information
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NPI Number | 1508255050
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Entity Type | Organization
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Legal Business Name | THOMAS REA PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 8701 GEORGIA AVE SUITE 511
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City | SILVER SPRING
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State | MD
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Zip | 20910-3713
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Country | US
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Telephone | 202-802-6901
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Fax |
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Provider Business Mailing Address
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Address Line | 8705 COLESVILLE RD #158
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City | SILVER SPRING
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State | MD
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Zip | 20910-3903
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Country | US
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Telephone | 202-802-6901
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS EDWARD REA II
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Credential | LCSW-C
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Telephone | 202-802-6901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 14632
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License Number State | MD
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