Provider Demographics
NPI:1760703516
Name:KUCH, SCHANLEY DOMINIQUE I
Entity Type:Individual
Prefix:MR
First Name:SCHANLEY
Middle Name:DOMINIQUE
Last Name:KUCH
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18509 QUEEN ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1347
Mailing Address - Country:US
Mailing Address - Phone:301-802-0872
Mailing Address - Fax:
Practice Address - Street 1:18509 QUEEN ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1347
Practice Address - Country:US
Practice Address - Phone:301-802-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health