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General NPI Number Information
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NPI Number | 1689199952
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Entity Type | Organization
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Legal Business Name | DXT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 7610 PENNSYLVANIA AVE STE 301
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City | FORESTVILLE
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State | MD
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Zip | 20747-4701
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Country | US
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Telephone | 240-284-6228
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Fax | 240-470-1223
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Provider Business Mailing Address
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Address Line | 3314 VALLEY FOREST DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-9400
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Country | US
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Telephone | 240-676-2895
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHELLE HARE
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Credential | LCPC LPC
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Telephone | 240-676-2895
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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 | LC7448
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License Number State | MD
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