MEDICARE: PYRAMID WALDEN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053611616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PYRAMID WALDEN, LLC

Provider Business Mailing Address
First Line	:	30007 BUSINESS CENTER DR
Second Line	:
City	:	CHARLOTTE HALL
State	:	MD
Zip	:	20622-3101
Country	:	US
Telephone Number	:	301-997-1300
Fax Number	:	301-863-4744

Provider Business Practice Location Address
First Line	:	85 HIGH ST
Second Line	:	SUITE 4
City	:	WALDORF
State	:	MD
Zip	:	20602-2150
Country	:	US
Telephone Number	:	301-997-1300
Fax Number	:	301-863-4744

Authorized Official
Title or Position	:	CEO
Name	:	JASON HENDRICKS
Credential	:
Telephone Number	:	814-940-0407

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	04/10/2024

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