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General NPI Number Information
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NPI Number | 1639565336
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Entity Type | Organization
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Legal Business Name | FUSION INTERNATIONAL
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 7453 HICKORY LOG CIR SUITE1
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City | COLUMBIA
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State | MD
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Zip | 21045-5027
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Country | US
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Telephone | 443-472-7314
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Fax |
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Provider Business Mailing Address
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Address Line | 7453 HICKORY LOG CIRCLE
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City | COLUMBIA
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State | MD
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Zip | 21045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | THELMA WILLIAMS
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Credential |
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Telephone | 701-220-5971
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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 | 4724
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License Number State | ND
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