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General NPI Number Information
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NPI Number | 1558695338
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Entity Type | Organization
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Legal Business Name | LISAMARIE EUSTICE, LLC
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 4829 WEST LN
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City | BETHESDA
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State | MD
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Zip | 20814-5317
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Country | US
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Telephone | 301-802-5697
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Fax |
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Provider Business Mailing Address
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Address Line | 4829 WEST LN
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City | BETHESDA
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State | MD
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Zip | 20814-5317
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Country | US
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Telephone | 301-802-5697
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/BUSINESS CO-OWNER
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Name | MS. LISAMARIE EUSTICE
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Credential | LCSW-C
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Telephone | 301-802-5697
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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 | 13843
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License Number State | MD
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