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General NPI Number Information
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NPI Number | 1801472634
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH SPECIALTY GROUP PA
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 4445 WILLARD AVE STE 600
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City | CHEVY CHASE
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State | MD
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Zip | 20815-3786
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746878
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City | ATLANTA
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State | GA
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Zip | 30374-6878
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Country | US
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Telephone | 323-205-7088
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Fax |
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Authorized Official
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Title or Position | OWNER/ AUTHORIZED OFFICIAL
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Name | MARK LEON WILLENBRING
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Credential |
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Telephone | 202-379-6736
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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 |
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License Number State |
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