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General NPI Number Information
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NPI Number | 1033846860
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Entity Type | Organization
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Legal Business Name | AZ'UELS COMMUNITY CONNECTIONS, INC
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 1975 SNYDER AVE
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City | DUNDALK
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State | MD
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Zip | 21222-1713
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Country | US
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Telephone | 240-583-0428
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Fax |
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Provider Business Mailing Address
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Address Line | 1975 SNYDER AVE
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City | DUNDALK
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State | MD
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Zip | 21222-1713
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Country | US
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Telephone | 240-583-0428
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MINI'IMAH WILSON
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Credential | MSW
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Telephone | 240-583-0428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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