Healthcare Provider Details

I. General information

NPI: 1942519202
Provider Name (Legal Business Name): WIN TEAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 EDMONDSON AVE
BALTIMORE MD
21229-1407
US

IV. Provider business mailing address

PO BOX 37
COLUMBIA MD
21045-0037
US

V. Phone/Fax

Practice location:
  • Phone: 443-919-9999
  • Fax:
Mailing address:
  • Phone: 410-578-8003
  • Fax: 410-578-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. AL W LAWS JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 443-858-8240