Provider Demographics
NPI:1790003564
Name:STEPHANIE WEILAND LLC
Entity Type:Organization
Organization Name:STEPHANIE WEILAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:WEILAND
Authorized Official - Last Name:KNARR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCMFT
Authorized Official - Phone:301-490-1011
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759
Mailing Address - Country:US
Mailing Address - Phone:301-490-1011
Mailing Address - Fax:301-490-1484
Practice Address - Street 1:9660 IRON LEAF TRAIL
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723
Practice Address - Country:US
Practice Address - Phone:301-490-1011
Practice Address - Fax:301-490-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLCM174OtherLICENSURE LCMFT