Organization
EPHESIANS LIFE MINISTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUNNY S PARK L.C.S.W.-C (THERAPIST)
(240) 472-3216
Entity
Organization
Contact information
Practice address
260 CEDAR LN SE # B, VIENNA, VA 22180-6698
(703) 204-0250
Mailing address
1620 ELTON RD STE 204, SILVER SPRING, MD 20903-1760
(301) 439-7191
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904005471
VA
101YM0800X
Mental Health Counselor
11220
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133171
MAMSI
MD
01
—
258321
KAISER
MD
01
—
351252
MHN
MD
01
—
633647
NCPPO
MD
01
—
7839381
AETNA
MD
Enumeration date
01/12/2007
Last updated
08/22/2020
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