1417202136 NPI number — DAWN OF A NEW DAY PASTORAL COUNSELING AND MENTORING SERVICES

Table of content: (NPI 1417202136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417202136 NPI number — DAWN OF A NEW DAY PASTORAL COUNSELING AND MENTORING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN OF A NEW DAY PASTORAL COUNSELING AND MENTORING SERVICES
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:
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:
1417202136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6368 COVENTRY WAY
Provider Second Line Business Mailing Address:
#386
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-214-3668
Provider Business Mailing Address Fax Number:
877-599-2585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9672 MARLBORO PIKE
Provider Second Line Business Practice Location Address:
UNIT J
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20772-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-214-3668
Provider Business Practice Location Address Fax Number:
877-599-2585
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
877-214-3668

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC3005 , 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: 04006610 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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