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General NPI Number Information
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NPI Number | 1366105306
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Entity Type | Organization
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Legal Business Name | LIGHTED PATH PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 5926 CECIL AVE
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City | GWYNN OAK
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State | MD
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Zip | 21207-5012
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Country | US
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Telephone | 301-318-0549
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Fax |
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Provider Business Mailing Address
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Address Line | 5926 CECIL AVE
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City | GWYNN OAK
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State | MD
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Zip | 21207-5012
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Country | US
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Telephone | 301-318-0549
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EILEEN K GRIFFIN
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Credential | PSYD
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Telephone | 301-318-0549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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