Healthcare Provider Details

I. General information

NPI: 1013831700
Provider Name (Legal Business Name): PATRICIA L PADGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11204 OLD YORK RD
BOWIE MD
20721-2218
US

IV. Provider business mailing address

11204 OLD YORK RD
BOWIE MD
20721-2218
US

V. Phone/Fax

Practice location:
  • Phone: 301-580-1713
  • Fax:
Mailing address:
  • Phone: 301-580-1713
  • Fax: 301-580-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17856
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: