Individual
SUSAN EASTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 E DIAMOND AVE, GAITHERSBURG, MD 20877-5321
(301) 840-3200
Mailing address
610 E DIAMOND AVE, GAITHERSBURG, MD 20877-5321
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC1928
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
816700100
—
MD
Enumeration date
05/02/2007
Last updated
07/30/2008
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