Provider Demographics
NPI:1952817876
Name:CHOE, SONGI
Entity Type:Individual
Prefix:
First Name:SONGI
Middle Name:
Last Name:CHOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONG
Other - Middle Name:I
Other - Last Name:CHOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21313 VILLAGE GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6960
Mailing Address - Country:US
Mailing Address - Phone:301-830-0029
Mailing Address - Fax:
Practice Address - Street 1:21313 VILLAGE GREEN CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6960
Practice Address - Country:US
Practice Address - Phone:301-830-0029
Practice Address - Fax:301-830-0029
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MDLGP10975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician