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General NPI Number Information
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NPI Number | 1114103652
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Entity Type | Organization
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Legal Business Name | TRINITY FAMILY CARE SERVICES LLC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 311 N 4TH ST SUITE 1
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City | OAKLAND
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State | MD
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Zip | 21550-1371
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Country | US
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Telephone | 301-334-7855
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Fax |
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Provider Business Mailing Address
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Address Line | 311 N 4TH ST SUITE 1
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City | OAKLAND
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State | MD
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Zip | 21550-1371
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. EARL WILLIAM DUVALL III
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Credential | LCPC
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Telephone | 301-334-7855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC2616
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License Number State | MD
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