Provider Demographics
NPI:1225526783
Name:MARYLAND COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:MARYLAND COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST AND CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAL
Authorized Official - Middle Name:SADAN
Authorized Official - Last Name:ELITZUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:202-812-0008
Mailing Address - Street 1:3102 FAIRWEATHER CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-3021
Mailing Address - Country:US
Mailing Address - Phone:240-286-5386
Mailing Address - Fax:
Practice Address - Street 1:8720 GEORGIA AVE STE 708
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3602
Practice Address - Country:US
Practice Address - Phone:202-812-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDJ53-0000OtherCAREFIRST