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General NPI Number Information
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NPI Number | 1568177657
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Entity Type | Organization
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Legal Business Name | ECLECTIC THERAPY COLLECTIVE, LLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 6012 WALTON RD
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City | BETHESDA
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State | MD
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Zip | 20817-2519
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Country | US
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Telephone | 240-444-0843
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Fax |
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Provider Business Mailing Address
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Address Line | 6012 WALTON RD
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City | BETHESDA
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State | MD
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Zip | 20817-2519
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Country | US
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Telephone | 240-444-0843
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | ALEXIS BOWEN
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Credential | LCPC
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Telephone | 240-444-0843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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