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Organization subpart
No

Provider details

NPI number
Authorized official
ALISHIA SHIFFON ZIMMERMAN MA, LCPC (CEO)
(301) 728-2888
Entity
Organization

Contact information

Practice address
3261 OLD WASHINGTON RD STE 2020, WALDORF, MD 20602-3231
(301) 868-0400
(301) 868-9000
Mailing address
3261 OLD WASHINGTON RD STE 2020, WALDORF, MD 20602-3231
(301) 868-0400
(301) 868-9000

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC3205
MD
101YP2500X
Professional Counselor
LC5376
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
194801600
MD
Enumeration date
05/23/2015
Last updated
07/17/2024
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