Provider Demographics
NPI:1477688760
Name:JMD COUNSELING AND THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:JMD COUNSELING AND THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:JD,MSW
Authorized Official - Phone:301-891-2060
Mailing Address - Street 1:6930 CARROLL AVE
Mailing Address - Street 2:SUITE 905
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4423
Mailing Address - Country:US
Mailing Address - Phone:301-891-2060
Mailing Address - Fax:301-576-4461
Practice Address - Street 1:6930 CARROLL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4423
Practice Address - Country:US
Practice Address - Phone:301-891-2060
Practice Address - Fax:301-576-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty