Organization
BLUNTLY COACHED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GANIYAT BADMUS LCSW-C (CLINICAL DIRECTOR)
(443) 754-2164
Entity
Organization
Contact information
Practice address
30435 MOUNT VERNON RD, PRINCESS ANNE, MD 21853-1437
(443) 754-2164
Mailing address
30435 MOUNT VERNON RD, PRINCESS ANNE, MD 21853-1437
(443) 754-2164
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302168800
—
MD
Enumeration date
01/10/2020
Last updated
01/10/2020
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