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General NPI Number Information
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NPI Number | 1528532777
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Entity Type | Organization
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Legal Business Name | JODI WAYNE, LCSW-C, LLC
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Dates
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Enumeration Date | 01/21/2019
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 336 S MAIN ST STE 2CA
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City | BEL AIR
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State | MD
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Zip | 21014-3978
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Country | US
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Telephone | 443-417-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 121 BRIARCLIFF LN
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City | BEL AIR
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State | MD
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Zip | 21014-5555
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Country | US
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Telephone | 443-417-8011
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JOHANNA WAYNE
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Credential | LCSW-C
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Telephone | 443-417-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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