Provider Demographics
NPI:1548484843
Name:FATH, JOHN P (LCPC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:FATH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:GERALD
Other - Last Name:FATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1001 SPRING ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4022
Mailing Address - Country:US
Mailing Address - Phone:301-565-2145
Mailing Address - Fax:
Practice Address - Street 1:1001 SPRING ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4022
Practice Address - Country:US
Practice Address - Phone:301-565-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist