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General NPI Number Information
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NPI Number | 1689313520
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Entity Type | Organization
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Legal Business Name | PYRAMID WALDEN LLC
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 44871 SAINT ANDREWS CHURCH ROAD
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City | CALIFORNIA
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State | MD
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Zip | 20619
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Country | US
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Telephone | 301-997-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 44871 SAINT ANDREWS CHURCH ROAD
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City | CALIFORNIA
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State | MD
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Zip | 20619
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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 | CHIEF EXECUTIVE OFFICER
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Name | JASON HENDRICKS
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Credential |
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Telephone | 814-940-0407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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