Provider Demographics
NPI:1730755570
Name:SOSA, FERNANDO SAMUEL (LCPC)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:SAMUEL
Last Name:SOSA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FARMCREST CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-6043
Mailing Address - Country:US
Mailing Address - Phone:301-310-1325
Mailing Address - Fax:
Practice Address - Street 1:13 FARMCREST CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-6043
Practice Address - Country:US
Practice Address - Phone:301-310-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health