Provider Demographics
NPI:1528659489
Name:SANTELICES, MACARENA PAZ (LCPC)
Entity type:Individual
Prefix:
First Name:MACARENA
Middle Name:PAZ
Last Name:SANTELICES
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 1:4200 CATHEDRAL AVE NW APT 509
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4908
Mailing Address - Country:US
Mailing Address - Phone:240-506-3258
Mailing Address - Fax:
Practice Address - Street 1:7201 WISCONSIN AVE STE 700
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4810
Practice Address - Country:US
Practice Address - Phone:301-654-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health