Provider Demographics
NPI:1295365260
Name:MMC PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:MMC PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAD-MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCC
Authorized Official - Phone:202-505-1848
Mailing Address - Street 1:8601 GEORGIA AVE STE 712
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3439
Mailing Address - Country:US
Mailing Address - Phone:202-505-1848
Mailing Address - Fax:240-788-6198
Practice Address - Street 1:8601 GEORGIA AVE STE 712
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3439
Practice Address - Country:US
Practice Address - Phone:202-505-1848
Practice Address - Fax:240-788-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-18
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79805540Medicaid