Healthcare Provider Details

I. General information

NPI: 1881960821
Provider Name (Legal Business Name): PYRAMID WALDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30007 BUSINESS CENTER DR
CHARLOTTE HALL MD
20622-3101
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: 301-997-1321
Mailing address:
  • Phone: 301-997-1300
  • Fax: 301-997-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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