Healthcare Provider Details

I. General information

NPI: 1407545353
Provider Name (Legal Business Name): WAYPOINT ASSESSMENT AND CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DEFENSE HWY STE 203
ANNAPOLIS MD
21401-8922
US

IV. Provider business mailing address

203 HOLLAND RD
SEVERNA PARK MD
21146-3621
US

V. Phone/Fax

Practice location:
  • Phone: 410-684-3806
  • Fax:
Mailing address:
  • Phone: 410-544-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLYSON KETT WAGNER
Title or Position: OWNER
Credential: PSYD
Phone: 410-544-1598