Provider Demographics
NPI:1922713114
Name:LOVELY, MARY MICHELLE (LAC, NTP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHELLE
Last Name:LOVELY
Suffix:
Gender:F
Credentials:LAC, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10319 WESTLAKE DR UNIT 273
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6403
Mailing Address - Country:US
Mailing Address - Phone:240-600-1942
Mailing Address - Fax:
Practice Address - Street 1:11710 OLD GEORGETOWN RD APT 127
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-2691
Practice Address - Country:US
Practice Address - Phone:240-600-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 171400000X
MDU01816171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No171400000XOther Service ProvidersHealth & Wellness Coach