=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801547336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIDE BY SIDE COUNSELING & CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2022
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6203 EXECUTIVE BLVD
-----------------------------------------------------
City | NORTH BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-222-1529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6203 EXECUTIVE BOULEVARD
-----------------------------------------------------
City | NORTH BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-222-1529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT, THERAPIST
-----------------------------------------------------
Name | DR. XIAOFANG WANG LANTERMAN
-----------------------------------------------------
Credential | PH.D., LCMFT
-----------------------------------------------------
Telephone | 240-222-1529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------