Healthcare Provider Details

I. General information

NPI: 1659603322
Provider Name (Legal Business Name): PYRAMID WALDEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44867 ST. ANDREWS CHURCH ROAD
CALIFORNIA MD
20619
US

IV. Provider business mailing address

30007 BUSINESS CENTER DR
CHARLOTTE HALL MD
20622-3101
US

V. Phone/Fax

Practice location:
  • Phone: 301-997-1300
  • Fax: 301-863-3368
Mailing address:
  • Phone: 301-997-1300
  • Fax: 301-997-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: JASON HENDRICKS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 814-940-0407