Provider Demographics
NPI:1992088801
Name:PASTORAL FAMILY COUNSELING ASSOCIATES LLC
Entity type:Organization
Organization Name:PASTORAL FAMILY COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-622-1714
Mailing Address - Street 1:15113 CENTERGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905
Mailing Address - Country:US
Mailing Address - Phone:301-622-1714
Mailing Address - Fax:301-384-4221
Practice Address - Street 1:13925 NEW HAMPSHIRE AVE.
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-622-1714
Practice Address - Fax:301-684-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH90035Medicare UPIN