Provider Demographics
NPI:1306387360
Name:CAPITAL THERAPEUTIC SERVICES, LLCC
Entity Type:Organization
Organization Name:CAPITAL THERAPEUTIC SERVICES, LLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW
Authorized Official - Phone:240-432-4030
Mailing Address - Street 1:2204 E MARLBORO AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5205
Mailing Address - Country:US
Mailing Address - Phone:240-432-4030
Mailing Address - Fax:
Practice Address - Street 1:2204 E MARLBORO AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5205
Practice Address - Country:US
Practice Address - Phone:240-432-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty