Healthcare Provider Details

I. General information

NPI: 1912336736
Provider Name (Legal Business Name): DAGENHART HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

IV. Provider business mailing address

5301 BUCKEYSTOWN PIKE STE 170
FREDERICK MD
21704-8380
US

V. Phone/Fax

Practice location:
  • Phone: 240-575-9688
  • Fax:
Mailing address:
  • Phone: 240-575-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3464
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH C. DAGENHART
Title or Position: OWNER
Credential: LCPC
Phone: 240-575-9688