Provider Demographics
NPI:1316324130
Name:MENICK, DUSTIN (LCPC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:MENICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 SNUG HILL LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4057
Mailing Address - Country:US
Mailing Address - Phone:301-257-8833
Mailing Address - Fax:
Practice Address - Street 1:4815 SAINT ELMO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7061
Practice Address - Country:US
Practice Address - Phone:301-257-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional