1124234265 NPI number — WORDS OF LIFE DEVELOPMENT CENTER, LLC

Table of content: (NPI 1124234265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124234265 NPI number — WORDS OF LIFE DEVELOPMENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORDS OF LIFE DEVELOPMENT CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124234265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENN DALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20769-0401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-297-3988
Provider Business Mailing Address Fax Number:
240-206-9796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7829 BELLE POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-297-3988
Provider Business Practice Location Address Fax Number:
240-206-9796
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKWOOD
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
240-297-3988

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSYI000077 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 03769 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: $$$$$$$$$ . This is a "SSN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SSN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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