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General NPI Number Information
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NPI Number | 1417288978
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Entity Type | Individual
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Provider Name | WINTER CHANAL WESLEY LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 2303 WHEATLEY DR 204
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City | WOODLAWN
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State | MD
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Zip | 21207-7737
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Country | US
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Telephone | 443-316-8614
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Fax |
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Provider Business Mailing Address
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Address Line | 9026 ALLENSWOOD RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-3731
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Country | US
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Telephone | 757-581-1090
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15057
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License Number State | MD
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