Healthcare Provider Details

I. General information

NPI: 1639647183
Provider Name (Legal Business Name): D.A. WYNNE & ASSOCIATES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 NEW HAMPSHIRE AVE STE 206
SILVER SPRING MD
20903-1423
US

IV. Provider business mailing address

10230 NEW HAMPSHIRE AVE STE 206
SILVER SPRING MD
20903-1423
US

V. Phone/Fax

Practice location:
  • Phone: 301-439-6700
  • Fax:
Mailing address:
  • Phone: 301-439-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH C KRUEGER
Title or Position: CLINICAL DIRECTOR
Credential: LCSW-C
Phone: 301-439-6700