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General NPI Number Information
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NPI Number | 1992241004
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Entity Type | Individual
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Provider Name | COLLEEN DESMOND LGPC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 223 KENT OAKS WAY
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5614
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Country | US
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Telephone | 301-706-4577
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Fax |
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Provider Business Mailing Address
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Address Line | 11904 DARNESTOWN RD STE F
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City | GAITHERSBURG
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State | MD
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Zip | 20878-3202
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Country | US
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Telephone | 301-706-4577
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LGP7581
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License Number State | MD
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