Healthcare Provider Details

I. General information

NPI: 1356264808
Provider Name (Legal Business Name): WRIGHTS BROTHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 GOOSE CREEK WAY
FREDERICK MD
21702-6034
US

IV. Provider business mailing address

2012 GOOSE CREEK WAY
FREDERICK MD
21702-6034
US

V. Phone/Fax

Practice location:
  • Phone: 301-473-2009
  • Fax: 301-473-2009
Mailing address:
  • Phone: 301-473-2009
  • Fax: 301-473-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA ALLEN
Title or Position: CEO
Credential: ALLEN
Phone: 301-473-2009