| Makonnen Therapeutic Services | |
|
881 Flagler Dr Gaithersburg MD 20878-1968 | |
| (410) 422-3386 | |
| Not Available |
| Full Name | Makonnen Therapeutic Services |
|---|---|
| Speciality | Counselor - Professional |
| Location | 881 Flagler Dr, Gaithersburg, Maryland |
| Authorized Official Name and Position | Raejon Lynne Makonnen (OWNER) |
| Authorized Official Contact | 4104223386 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Makonnen Therapeutic Services 881 Flagler Dr Gaithersburg MD 20878-1968 Ph: (410) 422-3386 | Makonnen Therapeutic Services 881 Flagler Dr Gaithersburg MD 20878-1968 Ph: (410) 422-3386 |
| NPI Number | 1558893586 |
|---|---|
| Provider Enumeration Date | 03/29/2017 |
| Last Update Date | 03/29/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558893586 | NPI | - | NPPES |
| 1143824 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC7426 (Maryland) | Primary |
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