Provider Demographics
NPI:1407503139
Name:UNDER THE MOON COUNSELING
Entity Type:Organization
Organization Name:UNDER THE MOON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNTANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-707-8361
Mailing Address - Street 1:1012 CAPISTRANO CT APT 302
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6305
Mailing Address - Country:US
Mailing Address - Phone:240-707-8361
Mailing Address - Fax:
Practice Address - Street 1:1012 CAPISTRANO CT APT 302
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6305
Practice Address - Country:US
Practice Address - Phone:240-707-8361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)