| Organization Name: | EXPRESSIVE THERAPY CENTER, LLC |
| NPI Number: | 1013158310 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IVAN MICHAEL NALIBOTSKY (EXECUTIVE DIRECTOR) |
| Mailing Address: | 14808 Physicians Ln Ste 111 Rockville |
| State: | MD US |
| Postal Code: | 208503907 |
| Phone Number: | 3018384112 |
| Fax Number: | 3018380623 |
| NPI Enumeration Date: | 03/16/2009 |
| NPI Last Update Date: | 03/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 11057 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |