Healthcare Provider Details

I. General information

NPI: 1154168987
Provider Name (Legal Business Name): PRECIOUS MAZIE HEYWARD-BLANDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 COLUMBIA RD NW
WASHINGTON DC
20009-4705
US

IV. Provider business mailing address

9530 BALTIMORE AVE APT 433
COLLEGE PARK MD
20740-1322
US

V. Phone/Fax

Practice location:
  • Phone: 202-319-2268
  • Fax:
Mailing address:
  • Phone: 347-793-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLG200002944
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: