Healthcare Provider Details

I. General information

NPI: 1316341761
Provider Name (Legal Business Name): CENTER FOR PROGRESSIVE LEARNING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 REDLAND CT SUITE 204
OWINGS MILLS MD
21117-3264
US

IV. Provider business mailing address

500 REDLAND CT SUITE 204
OWINGS MILLS MD
21117-3264
US

V. Phone/Fax

Practice location:
  • Phone: 410-581-7800
  • Fax: 410-581-0036
Mailing address:
  • Phone: 410-581-7800
  • Fax: 410-581-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY HENDERSON
Title or Position: COO
Credential:
Phone: 410-581-7800