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General NPI Number Information
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NPI Number | 1871728030
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Entity Type | Organization
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Legal Business Name | MRB COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 317 E DIAMOND AVE SUITE C
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City | GAITHERSBURG
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State | MD
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Zip | 20877-3093
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Country | US
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Telephone | 301-527-0854
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Fax | 240-243-1061
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Provider Business Mailing Address
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Address Line | 317 E DIAMOND AVE SUITE C
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City | GAITHERSBURG
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State | MD
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Zip | 20877-3093
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Country | US
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Telephone | 301-527-0854
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Fax | 240-243-1061
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA ROSA BUSTOS
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Credential | PH.D
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Telephone | 301-512-0663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 903540
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA368
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC1437
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11362
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License Number State | MD
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