Healthcare Provider Details

I. General information

NPI: 1508386079
Provider Name (Legal Business Name): HOWARD COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 TRUMPETER ROAD HCHD WILDE LAKE HIGH SCHOOL-BASED WELLNESS CENTER
COLUMBIA MD
21044-2314
US

IV. Provider business mailing address

8930 STANFORD BOULEVARD HOWARD COUNTY HEALTH DEPARTMENT
COLUMBIA MD
21045-5805
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-7238
  • Fax: 410-313-6108
Mailing address:
  • Phone: 410-313-7238
  • Fax: 410-313-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: CARLETTA LYNN MCKNIGHT
Title or Position: FISCAL ACCOUNT MANAGER
Credential:
Phone: 410-313-6300