Basic Information
Provider Information
NPI: 1437718780
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SYDNOR
FirstName: MECHIA
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: LCPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 WOOD HILL RD
Address2:  
City: ROCKVILLE
State: MD
PostalCode: 208508724
CountryCode: US
TelephoneNumber: 3018384200
FaxNumber: 3014681862
Practice Location
Address1: 200 WOOD HILL RD
Address2:  
City: ROCKVILLE
State: MD
PostalCode: 208508724
CountryCode: US
TelephoneNumber: 3018384200
FaxNumber: 3014681862
Other Information
ProviderEnumerationDate: 06/11/2019
LastUpdateDate: 07/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XLC11582MDY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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