Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC5014 | MD |
NPI | 1003175381 |
---|---|
Provider Name | Ms. Judy Wang |
First Address | Gaithersburg, MD 20883-3545 |
Second Address | Bethesda, MD 20814-4575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2012 |
Last Update Date | 17/03/2018 |