Healthcare Provider Details

I. General information

NPI: 1295398154
Provider Name (Legal Business Name): BUILDING BLOCKS HEALTHCARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13603 MARY BOWIE PKWY
UPPER MARLBORO MD
20774-9075
US

IV. Provider business mailing address

13603 MARY BOWIE PKWY
UPPER MARLBORO MD
20774-9075
US

V. Phone/Fax

Practice location:
  • Phone: 443-651-4019
  • Fax:
Mailing address:
  • Phone: 443-651-4019
  • Fax: 443-898-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTY TERESA GODWIN
Title or Position: OWNER
Credential:
Phone: 443-651-4019