MEDICARE: A STEP AHEAD PREVENTIVE AND HOLISTIC WELLNESS CENTER 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	103T00000X	Psychologist	03977	MD

General Provider Information

NPI Number	:	1386135333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A STEP AHEAD PREVENTIVE AND HOLISTIC WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	14933 NASHUA LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1005
Country	:	US
Telephone Number	:	301-503-1519
Fax Number	:	301-281-4002

Provider Business Practice Location Address
First Line	:	4500 FORBES BLVD # 200-W12
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-6312
Country	:	US
Telephone Number	:	301-503-1519
Fax Number	:

Authorized Official
Title or Position	:	BILLAR
Name	:	PRIYANKA MALHOTRA
Credential	:
Telephone Number	:	301-377-1836

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	05/25/2018

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