Individual
JZUA KURNIAWANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8654 INDIAN SPRINGS RD, FREDERICK, MD 21702-2328
(240) 383-5874
Mailing address
8654 INDIAN SPRINGS RD, FREDERICK, MD 21702-2328
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/13/2024
Last updated
03/13/2024
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