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General NPI Number Information
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NPI Number | 1912692609
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Entity Type | Individual
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Provider Name | LAURA DINE MBENG LPC
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 4545 42ND ST NW STE 105
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City | WASHINGTON
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State | DC
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Zip | 20016-4623
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Country | US
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Telephone | 571-236-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 4530 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20016-4627
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Country | US
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Telephone | 202-536-4414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC200002191
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License Number State | DC
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Taxonomy #2
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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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