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General NPI Number Information
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NPI Number | 1700376563
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Entity Type | Individual
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Provider Name | EMILY WIETMARSCHEN
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Gender | Female
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 10005 OLD COLUMBIA RD STE L260
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City | COLUMBIA
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State | MD
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Zip | 21046-1722
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Country | US
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Telephone | 443-259-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 16TH ST APT T2
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City | SILVER SPRING
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State | MD
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Zip | 20910-2928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LGPC00187
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC8658
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License Number State | MD
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