Healthcare Provider Details

I. General information

NPI: 1477984797
Provider Name (Legal Business Name): LAKKISHA DRYDEN CSC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 CRISFIELD HWY
WESTOVER MD
21871-3922
US

IV. Provider business mailing address

7920 CRISFIELD HWY
WESTOVER MD
21871-3922
US

V. Phone/Fax

Practice location:
  • Phone: 443-523-1790
  • Fax: 410-651-3189
Mailing address:
  • Phone: 443-523-1790
  • Fax: 410-651-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSC1859
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: