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Organization

HEALTH AND HUMAN SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LACEY GHOLSON (ADMINISTRATIVE OFFICER)
(301) 496-4506
Entity
Organization

Contact information

Practice address
9000 ROCKVILLE PIKE, BUILDING 10 ROOM 1C711 MSC 1184, BETHESDA, MD 20892-0001
(301) 435-4801
Mailing address
9000 ROCKVILLE PIKE, BUILDING 10 ROOM 1C711 MSC 1184, BETHESDA, MD 20892-0001

Taxonomy

Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
19956
AL

Other

Enumeration date
04/05/2016
Last updated
04/05/2016
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