Provider Demographics
NPI:1245966951
Name:MINDSPACE CLINICAL COUNSELING LLC
Entity type:Organization
Organization Name:MINDSPACE CLINICAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-394-6530
Mailing Address - Street 1:9711 WASHINGTONIAN BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5789
Mailing Address - Country:US
Mailing Address - Phone:202-487-3813
Mailing Address - Fax:
Practice Address - Street 1:12345 PARKLAWN DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1725
Practice Address - Country:US
Practice Address - Phone:240-394-6530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health