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General NPI Number Information
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NPI Number | 1760863666
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Entity Type | Organization
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Legal Business Name | COACHING FOR THE VOYAGE
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 23123 CAMDEN WAY
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City | CALIFORNIA
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State | MD
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Zip | 20619-2446
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Country | US
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Telephone | 240-538-2577
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Fax | 888-974-6528
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | MECHANICSVILLE
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State | MD
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Zip | 20659-0065
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Country | US
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Telephone | 240-538-2577
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Fax | 888-974-6528
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. DONNA BENNETT
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Credential | LCSW-C
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Telephone | 240-538-2577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09312
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License Number State | MD
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