Healthcare Provider Details

I. General information

NPI: 1699289843
Provider Name (Legal Business Name): BIRDIES NEST THERAPEUTIC & CONSULTING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 SILVER PARK TER
SUITLAND MD
20746-3047
US

IV. Provider business mailing address

2612 TALBOT CT
WALDORF MD
20602-2017
US

V. Phone/Fax

Practice location:
  • Phone: 240-523-3381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. SABRIE RENEE WIGGINS-ROSE
Title or Position: CEO AND FOUNDER/ LEAD CLINICIAN
Credential: LCPC-S
Phone: 240-523-3381