Organization
EXPRESSIVE THERAPY CENTER, LLC
Active
Organization
EXPRESSIVE THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IVAN MICHAEL NALIBOTSKY (EXECUTIVE DIRECTOR)
(301) 838-4112
Entity
Organization
Contact information
Practice address
14808 PHYSICIANS LN STE 111, ROCKVILLE, MD 20850-3907
(301) 838-4112
(301) 838-0623
Mailing address
13153 BRUSHWOOD WAY, POTOMAC, MD 20854-1025
(301) 838-4112
(301) 838-0623
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
03948
MD
1041C0700X
Clinical Social Worker
11057
MD
1041C0700X
Clinical Social Worker
12681
MD
106H00000X
Marriage & Family Therapist
MFC 26055
MD
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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