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NPI Code Detail

MEDICARE: JONATHAN TAKANG LGPC

MEDICARE: JONATHAN TAKANG LGPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor
2101YP2500XProfessional CounselorLGP13283MD

General Provider Information

NPI Number : 1215283460
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN TAKANG LGPC
Provider Business Mailing Address
First Line : 14440 CHERRY LANE CT STE 208
Second Line :
City : LAUREL
State : MD
Zip : 20707-4946
Country : US
Telephone Number : 301-604-1458
Fax Number : 301-604-1459
Provider Business Practice Location Address
First Line : 20 W WASHINGTON ST STE 503
Second Line :
City : HAGERSTOWN
State : MD
Zip : 21740-4520
Country : US
Telephone Number : 301-393-3949
Fax Number : 301-745-3482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2012
Last Update Date : 05/19/2023

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