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General NPI Number Information
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NPI Number | 1679931273
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Entity Type | Organization
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Legal Business Name | FOUNDATION PSYCHOTHERAPY AND COUNSELING, LLC
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 2919 OLNEY SANDY SPRING RD STE A
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City | OLNEY
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State | MD
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Zip | 20832-1587
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Country | US
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Telephone | 301-254-3972
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Fax |
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Provider Business Mailing Address
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Address Line | 6123 WHITE MARBLE CT
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1658
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Country | US
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Telephone | 301-254-3972
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CLINICAL DIRECTOR
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Name | MS. DEBORAH ANNE IRVIN
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Credential | LCSW-C
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Telephone | 301-254-3972
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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 | 12403
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License Number State | MD
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