Provider Demographics
NPI:1134831522
Name:POFFENROTH, POLLY (LGPC)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:POFFENROTH
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E WEST HWY APT 1216
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6211
Mailing Address - Country:US
Mailing Address - Phone:301-893-4733
Mailing Address - Fax:
Practice Address - Street 1:8720 GEORGIA AVE STE 906
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3635
Practice Address - Country:US
Practice Address - Phone:301-893-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health