Organization
LEAD4LIFE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M GAUTHIER MSW (EXECUTIVE DIRECTOR)
(301) 672-4319
Entity
Organization
Contact information
Practice address
15825 SHADY GROVE RD STE 35, ROCKVILLE, MD 20850-4033
(301) 672-4319
Mailing address
15825 SHADY GROVE RD STE 35, ROCKVILLE, MD 20850-4033
(240) 499-8949
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201507200
—
MD
Enumeration date
08/13/2018
Last updated
08/13/2018
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