Provider Demographics
NPI:1942786967
Name:NORA TALAVERA WELLNESS & HEALTH MENTAL LLC
Entity Type:Organization
Organization Name:NORA TALAVERA WELLNESS & HEALTH MENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:IVONNE
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-704-5799
Mailing Address - Street 1:10433 CARLYN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2158
Mailing Address - Country:US
Mailing Address - Phone:301-704-5799
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 502
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1222
Practice Address - Country:US
Practice Address - Phone:301-704-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)