=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801303953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALICIA BELTRAN LCPC AND ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2018
-----------------------------------------------------
Last Update Date | 01/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 966 HUNGERFORD DR STE 20B
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-922-5759
-----------------------------------------------------
Fax | 240-238-3044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4008 SPARROW HOUSE LN
-----------------------------------------------------
City | BURTONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20866-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-922-5759
-----------------------------------------------------
Fax | 240-238-3044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PSYCHOTHERAPIST
-----------------------------------------------------
Name | ALICIA BELTRAN
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 301-922-5759
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC4796
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------