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General NPI Number Information
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NPI Number | 1225799547
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Entity Type | Organization
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Legal Business Name | SOVEREIGN CONSULTING GROUP LLC
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Dates
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Enumeration Date | 01/08/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 11110 MALL CIR # 6301
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City | WALDORF
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State | MD
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Zip | 20603-1800
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Country | US
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Telephone | 240-270-1183
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6301
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City | WALDORF
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State | MD
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Zip | 20603-6301
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Country | US
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Telephone | 240-270-1183
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | SHIRETTA DENISE WARREN
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Credential | LCSW-C
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Telephone | 240-565-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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