Healthcare Provider Details

I. General information

NPI: 1962906842
Provider Name (Legal Business Name): CHRISTOPHER WU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 COLUMBIA 100 PKWY
COLUMBIA MD
21045-2361
US

IV. Provider business mailing address

8815 COLUMBIA 100 PKWY STE 4
COLUMBIA MD
21045-2361
US

V. Phone/Fax

Practice location:
  • Phone: 877-776-8502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberRBT-17-46121
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: