Organization
LEAD4LIFE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M GAUTHIER (CEO EXECUTIVE DIRECTOR)
(301) 672-4319
Entity
Organization
Contact information
Practice address
176 THOMAS JOHNSON DR STE 203, FREDERICK, MD 21702-4535
(301) 672-4319
Mailing address
2096 GAITHER RD STE 110, ROCKVILLE, MD 20850-4027
(301) 672-4319
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201507200
—
MD
Enumeration date
08/19/2019
Last updated
08/19/2019
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