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General NPI Number Information
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NPI Number | 1558994517
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Entity Type | Organization
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Legal Business Name | OPEN HEARTS THERAPY SERVICES LLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 15717 CRABBS BRANCH WAY
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City | ROCKVILLE
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State | MD
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Zip | 20855-6650
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Country | US
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Telephone | 301-637-2792
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Fax | 844-375-0213
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Provider Business Mailing Address
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Address Line | 17604 PHELPS HILL LN
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City | DERWOOD
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State | MD
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Zip | 20855-1358
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Country | US
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Telephone | 913-963-7133
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Fax | 844-375-0213
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAGAIL JEANEAN WILSON
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Credential | LCMFT
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Telephone | 301-637-2792
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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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