Healthcare Provider Details

I. General information

NPI: 1750597589
Provider Name (Legal Business Name): ADONA IRENE WIMBERLY PH.D., L.C.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. ADONA IRENE WRIGHT

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK RD STE 506
LUTHERVILLE MD
21093-6022
US

IV. Provider business mailing address

9565 LONG LOOK LN
COLUMBIA MD
21045-3241
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-2281
  • Fax: 410-825-2280
Mailing address:
  • Phone: 443-621-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCA124
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA124
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04227
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: