Healthcare Provider Details

I. General information

NPI: 1679408892
Provider Name (Legal Business Name): DAJAH CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3078 WALDORF MARKET PL
WALDORF MD
20603-4872
US

IV. Provider business mailing address

6919 CARIBOU CT
WALDORF MD
20603-4311
US

V. Phone/Fax

Practice location:
  • Phone: 240-603-0931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: