Healthcare Provider Details

I. General information

NPI: 1275615338
Provider Name (Legal Business Name): PCC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 RITCHIE HWY SUITE G
PASADENA MD
21122-6940
US

IV. Provider business mailing address

8131 RITCHIE HWY SUITE G
PASADENA MD
21122-6940
US

V. Phone/Fax

Practice location:
  • Phone: 410-360-4774
  • Fax: 410-544-4928
Mailing address:
  • Phone: 410-360-4774
  • Fax: 410-544-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GEORGE M ANDREWS
Title or Position: OWNER
Credential:
Phone: 443-591-0230