Healthcare Provider Details

I. General information

NPI: 1700723558
Provider Name (Legal Business Name): MARYLAND PSYCHIATRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13168 CENTERPOINTE WAY STE 201
WOODBRIDGE VA
22193-5287
US

IV. Provider business mailing address

13168 CENTERPOINTE WAY STE 201
WOODBRIDGE VA
22193-5287
US

V. Phone/Fax

Practice location:
  • Phone: 240-585-5142
  • Fax: 240-448-6798
Mailing address:
  • Phone: 240-585-5142
  • Fax: 240-448-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN LINDSEY
Title or Position: PARTNER
Credential:
Phone: 301-979-8300