Organization
LAVI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOLANDA HAYES (CREDENTIALING SPECIALIST)
(443) 345-1317
Entity
Organization
Contact information
Practice address
10670 SOURWOOD AVE, WALDORF, MD 20603-5716
(301) 579-4854
Mailing address
10670 SOURWOOD AVE, WALDORF, MD 20603-5716
(301) 579-4854
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
Other
Enumeration date
04/16/2021
Last updated
08/09/2021
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