Healthcare Provider Details

I. General information

NPI: 1205387438
Provider Name (Legal Business Name): SYKESVILLE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7524 MAIN ST # 101
SYKESVILLE MD
21784
US

IV. Provider business mailing address

7434 SPRINGFIELD AVE
SYKESVILLE MD
21784-7550
US

V. Phone/Fax

Practice location:
  • Phone: 410-746-5868
  • Fax:
Mailing address:
  • Phone: 410-746-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLGSW21578
License Number StateMD

VIII. Authorized Official

Name: WHITNEY THOMPSON
Title or Position: OWNER
Credential: LCPC
Phone: 410-746-5868