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General NPI Number Information
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NPI Number | 1740725480
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Entity Type | Organization
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Legal Business Name | BETHESDA PLAY THERAPY AND HEALING, LLC
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 7815A OLD GEORGETOWN RD STE 205
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City | BETHESDA
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State | MD
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Zip | 20814-2462
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Country | US
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Telephone | 443-677-9290
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 WISCONSIN AVE APT 1212
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City | BETHESDA
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State | MD
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Zip | 20814-3122
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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 | OWNER, PSYCHOTHERAPIST
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Name | NIKI PICOGNA
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Credential | LCPC
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Telephone | 443-677-9290
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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 | LC3568
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License Number State | MD
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