Healthcare Provider Details

I. General information

NPI: 1619443660
Provider Name (Legal Business Name): MARY CHAMBERS-WOODLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 07/17/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DUKE ST # 203
PRINCE FREDERICK MD
20678-6128
US

IV. Provider business mailing address

65 DUKE ST # 203
PRINCE FREDERICK MD
20678-6128
US

V. Phone/Fax

Practice location:
  • Phone: 443-295-8955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC8244
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: