Healthcare Provider Details

I. General information

NPI: 1225953573
Provider Name (Legal Business Name): NYMPHALIDAE TRANSITIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11177 CONWAY PL
WHITE PLAINS MD
20695-4297
US

IV. Provider business mailing address

11177 CONWAY PL
WHITE PLAINS MD
20695-4297
US

V. Phone/Fax

Practice location:
  • Phone: 240-370-9076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMICA WELLS
Title or Position: LCSW
Credential: LCSW
Phone: 240-370-9076