Healthcare Provider Details

I. General information

NPI: 1922669753
Provider Name (Legal Business Name): QUIANA WADE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 FREDERICK RD
GAITHERSBURG MD
20877-4039
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 730
GREENBELT MD
20770-3523
US

V. Phone/Fax

Practice location:
  • Phone: 208-779-0036
  • Fax:
Mailing address:
  • Phone: 301-345-1022
  • Fax: 301-560-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: