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General NPI Number Information
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NPI Number | 1376152678
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Entity Type | Individual
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Provider Name | GWENDOLYN MAURICE LPA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 739 CHERRY HILL RD
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City | HEATHSVILLE
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State | VA
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Zip | 22473-2648
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Country | US
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Telephone | 571-276-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 4TH ST SE APT 733
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City | WASHINGTON
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State | DC
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Zip | 20003-3498
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Country | US
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Telephone | 860-575-8347
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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