Organization
BLANK-PAGES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LASHAY JOHNSON (OWNER)
(202) 567-9199
Entity
Organization
Contact information
Practice address
3200 CRAIN HWY, 203, WALDORF, MD 20603-4841
(202) 567-9199
Mailing address
4019 NIGHT HERON CT, B, WALDORF, MD 20603-4673
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LC6054
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251042100
—
MD
01
—
879798
BEACON
MD
Enumeration date
02/03/2017
Last updated
02/03/2017
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