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General NPI Number Information
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NPI Number | 1083336580
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Entity Type | Organization
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Legal Business Name | ETW THERAPEUTIC & HOLISTIC SERVICES LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 7305 BALTIMORE AVE STE A101
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City | COLLEGE PARK
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State | MD
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Zip | 20740-3234
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Country | US
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Telephone | 410-824-1480
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Fax | 410-824-1482
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Provider Business Mailing Address
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Address Line | 7206 SHOCKLEY CT
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City | FT WASHINGTON
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State | MD
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Zip | 20744-1711
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Country | US
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Telephone | 410-824-1480
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Fax | 410-824-1482
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | PRIYANKA MALHOTRA
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Credential |
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Telephone | 13-771-8363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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