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General NPI Number Information
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NPI Number | 1417338849
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Entity Type | Organization
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Legal Business Name | SD AVINGER CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 600 WYNDHURST AVE STE 306
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City | BALTIMORE
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State | MD
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Zip | 21210-2415
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Country | US
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Telephone | 267-235-4263
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Fax | 443-279-2916
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Provider Business Mailing Address
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Address Line | 600 WYNDHURST AVE STE 306
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City | BALTIMORE
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State | MD
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Zip | 21210-2415
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Country | US
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Telephone | 267-235-4263
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Fax | 443-279-2916
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Authorized Official
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Title or Position | PROVIDER/ OWNER
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Name | STEPHANIE D AVINGER
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Credential | LCSW-C
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Telephone | 267-235-4263
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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 | 19606
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License Number State | MD
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