Healthcare Provider Details

I. General information

NPI: 1902366453
Provider Name (Legal Business Name): DESIRED SOCIAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13206 IDLEWILD DR
BOWIE MD
20715-1406
US

IV. Provider business mailing address

13206 IDLEWILD DR
BOWIE MD
20715-1406
US

V. Phone/Fax

Practice location:
  • Phone: 216-965-4495
  • Fax:
Mailing address:
  • Phone: 216-965-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DESIREE R WASHINGTON
Title or Position: OWNER
Credential: LCSW-C, LICSW
Phone: 240-245-4663