=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568974756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A WORK IN PROGRESS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2017
-----------------------------------------------------
Last Update Date | 10/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3261 OLD WASHINGTON RD STE 2020
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20602-3231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-435-2797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 WHISTLING WOOD CT
-----------------------------------------------------
City | ACCOKEEK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20607-2707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | DR. DEIRDRE CULLUM
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 240-435-2797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------