Healthcare Provider Details

I. General information

NPI: 1295432755
Provider Name (Legal Business Name): ENOVED CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 11/05/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 205
WALDORF MD
20601-2816
US

IV. Provider business mailing address

2670 CRAIN HWY STE 205
WALDORF MD
20601-2816
US

V. Phone/Fax

Practice location:
  • Phone: 301-363-4900
  • Fax:
Mailing address:
  • Phone: 240-417-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEVONE CLARICE WILLIAMS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 240-417-0586