Healthcare Provider Details

I. General information

NPI: 1326228719
Provider Name (Legal Business Name): WEST PSYCHOTHERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE B105
CLINTON MD
20735-1628
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE B105
CLINTON MD
20735-1628
US

V. Phone/Fax

Practice location:
  • Phone: 301-512-0445
  • Fax:
Mailing address:
  • Phone: 301-512-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03608
License Number StateMD

VIII. Authorized Official

Name: MS. SHEILA ANNE WEST
Title or Position: OWNER
Credential: LCSWC BCD
Phone: 301-512-0445