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General NPI Number Information
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NPI Number | 1366990921
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Entity Type | Organization
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Legal Business Name | SUNRISE THERAPEUTIC SERVICES, INC.
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 10111 MARTIN LUTHER KING JR HWY SUITE 103
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City | BOWIE
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State | MD
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Zip | 20720-4200
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Country | US
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Telephone | 240-383-6343
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Fax |
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Provider Business Mailing Address
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Address Line | 10111 MARTIN LUTHER KING JR HWY SUITE 103
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City | BOWIE
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State | MD
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Zip | 20720-4200
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Country | US
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Telephone | 240-383-6343
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YOLANDA YVETTE ROGERS
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Credential | LCPC
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Telephone | 240-383-6343
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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 | LC5754
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License Number State | MD
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