Provider Demographics
NPI:1063926608
Name:QI, FANGYU (LCSW-C)
Entity type:Individual
Prefix:
First Name:FANGYU
Middle Name:
Last Name:QI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 EXECUTIVE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3822
Mailing Address - Country:US
Mailing Address - Phone:917-435-7935
Mailing Address - Fax:
Practice Address - Street 1:6010 EXECUTIVE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3822
Practice Address - Country:US
Practice Address - Phone:240-447-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD220581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical