MEDICARE: WIZEMAN COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1134968472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIZEMAN COUNSELING

Provider Business Mailing Address
First Line	:	1910 TOWNE CENTRE BLVD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3598
Country	:	US
Telephone Number	:	443-732-0778
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 TOWNE CENTRE BLVD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3598
Country	:	US
Telephone Number	:	443-732-0778
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH CLINICIAN
Name	:	DANA SKOLNICK WIZEMAN
Credential	:	LPC
Telephone Number	:	443-732-0778

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/21/2026

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