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NPI Code Detail

MEDICARE: D.A. WYNNE & ASSOCIATES,INC.

MEDICARE: D.A. WYNNE & ASSOCIATES,INC.
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
1103TA0400XAddiction (Substance Use Disorder) Psychologist

Other Identifiers

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

General Provider Information

NPI Number : 1639647183
Entity Type Code : Organization
Provider Name (Legal Business Name) : D.A. WYNNE & ASSOCIATES,INC.
Provider Business Mailing Address
First Line : 10230 NEW HAMPSHIRE AVE STE 206
Second Line :
City : SILVER SPRING
State : MD
Zip : 20903-1423
Country : US
Telephone Number : 301-439-6700
Fax Number :
Provider Business Practice Location Address
First Line : 10230 NEW HAMPSHIRE AVE STE 206
Second Line :
City : SILVER SPRING
State : MD
Zip : 20903-1423
Country : US
Telephone Number : 301-439-6700
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : ELIZABETH C KRUEGER
Credential : LCSW-C
Telephone Number : 301-439-6700
Provider Enumeration Date : 11/02/2018
Last Update Date : 11/02/2018

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