Healthcare Provider Details

I. General information

NPI: 1447851993
Provider Name (Legal Business Name): PYRAMID WALDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44863 ST ANDREWS CHURCH ROAD
CALIFORNIA MD
20619
US

IV. Provider business mailing address

PO BOX 967
DUNCANSVILLE PA
16635-0967
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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