Healthcare Provider Details

I. General information

NPI: 1922406578
Provider Name (Legal Business Name): PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13900 LAUREL LAKES AVE SUITE 225
LAUREL MD
20707-5091
US

IV. Provider business mailing address

13900 LAUREL LAKES AVE SUITE 225
LAUREL MD
20707-5091
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-4500
  • Fax:
Mailing address:
  • Phone: 301-498-4500
  • Fax: 301-498-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WRIGHT F DOSS
Title or Position: ASSOCIATE DIRECTOR
Credential: LCSW-C
Phone: 301-883-7903