Individual
MR. JASON DAVID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7008 WICK LN, DERWOOD, MD 20855-1963
(301) 401-2047
Mailing address
7008 WICK LN, DERWOOD, MD 20855-1963
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA1982
MD
101YP2500X
Professional Counselor
Primary
LC5148
MD
Other
Enumeration date
07/31/2013
Last updated
07/31/2013
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