Provider Demographics
NPI:1407415847
Name:HERNANDEZ, JOSE (LGPC)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 TECH RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1913
Mailing Address - Country:US
Mailing Address - Phone:301-572-6585
Mailing Address - Fax:301-572-7913
Practice Address - Street 1:12200 TECH RD STE 330
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1913
Practice Address - Country:US
Practice Address - Phone:301-572-6585
Practice Address - Fax:301-572-7913
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional