Provider Demographics
NPI:1710530936
Name:CONWAY, RICHARD THOMAS JR (LGPAT, LGPC, ATR-P)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:CONWAY
Suffix:JR
Gender:M
Credentials:LGPAT, LGPC, ATR-P
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGPAT, LGPC, ATR-P
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 700B
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3523
Mailing Address - Country:US
Mailing Address - Phone:240-304-3327
Mailing Address - Fax:240-513-4155
Practice Address - Street 1:17904 GEORGIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2277
Practice Address - Country:US
Practice Address - Phone:240-204-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATG223221700000X
MDLGP9412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist