=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902664949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENOUGH FOR EMMIE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2024
-----------------------------------------------------
Last Update Date | 04/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 LAWNDALE DR
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716-3553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-281-4247
-----------------------------------------------------
Fax | 301-245-2024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12530 FAIRWOOD PARKWAY STE 102 PMB# 1273
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20720-6357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-281-4247
-----------------------------------------------------
Fax | 301-245-2024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING OWNER
-----------------------------------------------------
Name | ELIZABETH MELCHIONE
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 301-281-4247
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------