Provider Demographics
NPI:1013635820
Name:LOUFIK, JONATHAN KENNA
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:KENNA
Last Name:LOUFIK
Suffix:
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 1:8919 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4104
Mailing Address - Country:US
Mailing Address - Phone:240-838-1062
Mailing Address - Fax:
Practice Address - Street 1:10012 COLESVILLE RD UNIT B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2306
Practice Address - Country:US
Practice Address - Phone:240-838-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC15636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional