Provider Demographics
NPI:1609382399
Name:IRWIN, MARA (LCPC)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19801 BAZZELLTON PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1432
Mailing Address - Country:US
Mailing Address - Phone:410-236-1882
Mailing Address - Fax:
Practice Address - Street 1:6411 ORCHARD AVE STE 207
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4712
Practice Address - Country:US
Practice Address - Phone:410-236-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional