Healthcare Provider Details

I. General information

NPI: 1538552641
Provider Name (Legal Business Name): WAYSTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 RTE 108
COLUMBIA MD
21045-1990
US

IV. Provider business mailing address

9030 RTE 108
COLUMBIA MD
21045-1990
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax: 410-740-2503
Mailing address:
  • Phone: 410-740-1901
  • Fax: 410-740-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLC6090
License Number StateMD

VIII. Authorized Official

Name: MS. CYNTHIA CISNEROS
Title or Position: BUSINESS MANAGER
Credential: LCPC
Phone: 410-741-1901