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General NPI Number Information
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NPI Number | 1629478045
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Entity Type | Organization
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Legal Business Name | CENTER FOR HOLISTIC MENTAL HEALTH AND SEXUAL THERAPY, LLC
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 1003 SPRING ST
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City | SILVER SPRING
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State | MD
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Zip | 20910
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Country | US
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Telephone | 240-449-4347
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Fax |
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Provider Business Mailing Address
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Address Line | 7604 ELIOAKTER
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City | GAITHERSBURG
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State | MD
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Zip | 20879
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Country | US
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Telephone | 240-449-4347
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID ALAN FISHMAN
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Credential | LCPC
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Telephone | 240-449-4347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC5248
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License Number State | MD
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