Individual
STACI BURROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11510 PEGASUS CT, UPPER MARLBORO, MD 20772-7823
(240) 221-1617
Mailing address
11510 PEGASUS CT, UPPER MARLBORO, MD 20772-7823
(240) 221-1617
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP11512
MD
Other
Enumeration date
04/08/2022
Last updated
04/08/2022
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