Provider Demographics
NPI:1710402383
Name:EMEN, ELIZABETH MARY (LCPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:EMEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:KUTTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 GEORGIA AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5242
Mailing Address - Country:US
Mailing Address - Phone:802-578-5794
Mailing Address - Fax:
Practice Address - Street 1:4000 BLACKBURN LN
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1104
Practice Address - Country:US
Practice Address - Phone:802-578-5794
Practice Address - Fax:802-578-5794
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional