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General NPI Number Information
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NPI Number | 1740783265
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Entity Type | Organization
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Legal Business Name | COMMITTED TO THE JOURNEY LLC
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Dates
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Enumeration Date | 03/11/2018
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Last Update Date | 03/11/2018
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Provider Practice Location Address
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Address Line | 1400 MERCANTILE LN STE 208
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City | LARGO
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State | MD
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Zip | 20774-5350
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Country | US
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Telephone | 202-681-5226
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Fax |
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Provider Business Mailing Address
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Address Line | 12138 CENTRAL AVE STE 145
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City | BOWIE
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State | MD
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Zip | 20721-1910
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Country | US
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Telephone | 202-681-5226
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SEMIKAH YISRAEL-JOHNSON
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Credential | LCMFT
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Telephone | 202-681-5226
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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 | LCM657
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGP7904
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LCM657
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LCM657
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License Number State | MD
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