Healthcare Provider Details

I. General information

NPI: 1245851443
Provider Name (Legal Business Name): WOMANHOOD COALITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SHADYWOOD CT
CROFTON MD
21114-1145
US

IV. Provider business mailing address

1505 SHADYWOOD CT
CROFTON MD
21114-1145
US

V. Phone/Fax

Practice location:
  • Phone: 240-800-6711
  • Fax:
Mailing address:
  • Phone: 240-800-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMBER RAE GILLIAN
Title or Position: CEO
Credential: MS, LCPC
Phone: 202-599-0917