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General NPI Number Information
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NPI Number | 1598934630
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Entity Type | Organization
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Legal Business Name | MELWOOD
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 12705 COUNTRY LN
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City | WALDORF
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State | MD
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Zip | 20601-3399
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Country | US
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Telephone | 301-870-6722
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Fax |
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Provider Business Mailing Address
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Address Line | 12705 COUNTRY LN
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City | WALDORF
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State | MD
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Zip | 20601-3399
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Country | US
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Telephone | 301-870-6722
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MR. ORLIE WHEATLY REID JR.
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Credential | LCSW-C
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Telephone | 301-870-6722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 12188
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License Number State | MD
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