Provider Demographics
NPI:1053517383
Name:AZURE, DON (MA)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:AZURE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WALNUTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1031
Mailing Address - Country:US
Mailing Address - Phone:301-602-3041
Mailing Address - Fax:301-740-9990
Practice Address - Street 1:4 PROFESSIONAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3407
Practice Address - Country:US
Practice Address - Phone:301-602-3041
Practice Address - Fax:301-740-9990
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health