Healthcare Provider Details

I. General information

NPI: 1023721420
Provider Name (Legal Business Name): YOLANDA COMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 MITCHELLVILLE RD STE 204
BOWIE MD
20716-3961
US

IV. Provider business mailing address

13103 HUNTERS RIDGE LN
BOWIE MD
20721-3283
US

V. Phone/Fax

Practice location:
  • Phone: 301-701-6965
  • Fax:
Mailing address:
  • Phone: 210-410-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGM925
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: