Provider Demographics
NPI:1003967563
Name:EPHESIANS LIFE MINISTRIES
Entity Type:Organization
Organization Name:EPHESIANS LIFE MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-472-3216
Mailing Address - Street 1:1620 ELTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1760
Mailing Address - Country:US
Mailing Address - Phone:301-439-7191
Mailing Address - Fax:
Practice Address - Street 1:260 CEDAR LN SE # B
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6698
Practice Address - Country:US
Practice Address - Phone:703-204-0250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11220101YM0800X
VA0904005471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7839381OtherAETNA
MD258321OtherKAISER
MD2133171OtherMAMSI
MD351252OtherMHN
MD633647OtherNCPPO
MD258321OtherKAISER