Healthcare Provider Details

I. General information

NPI: 1285299750
Provider Name (Legal Business Name): DANITA WYNES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8737 COLESVILLE RD STE 801
SILVER SPRING MD
20910-3968
US

IV. Provider business mailing address

8737 COLESVILLE RD
SILVER SPRING MD
20910-3928
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-8262
  • Fax:
Mailing address:
  • Phone: 301-960-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number06099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: