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General NPI Number Information
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NPI Number | 1669704706
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Entity Type | Organization
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Legal Business Name | POWDER MILL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 4041 POWDER MILL RD 5TH FLOOR
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City | BELTSVILLE
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State | MD
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Zip | 20705-3106
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Country | US
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Telephone | 301-595-0567
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Fax | 301-595-0754
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Provider Business Mailing Address
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Address Line | 4041 POWDER MILL RD 5TH FLOOR
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City | BELTSVILLE
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State | MD
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Zip | 20705-3106
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Country | US
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Telephone | 301-595-0567
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Fax | 301-595-0754
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Authorized Official
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Title or Position | PSYCHOLOGIST/PRESIDENT
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Name | WENDY SANORA BUSKEY
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Credential | PSYD
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Telephone | 301-273-2089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03868
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License Number State | MD
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