Provider Demographics
NPI:1750920294
Name:DYNAMIC COUNSELING GROUP
Entity type:Organization
Organization Name:DYNAMIC COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-346-1974
Mailing Address - Street 1:3375 MALCOLM RD
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-4029
Mailing Address - Country:US
Mailing Address - Phone:240-346-1974
Mailing Address - Fax:301-263-7894
Practice Address - Street 1:3195 OLD WASHINGTON RD STE 110
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3201
Practice Address - Country:US
Practice Address - Phone:240-346-1974
Practice Address - Fax:301-263-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)