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NPI Code Detail

MEDICARE: RIVERS OF HEALING LLC

MEDICARE: RIVERS OF HEALING 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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11336432749OTHERMDINDIVIDUAL NPI

General Provider Information

NPI Number : 1790257939
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERS OF HEALING LLC
Provider Business Mailing Address
First Line : 14502 GREENVIEW DR STE 550
Second Line :
City : LAUREL
State : MD
Zip : 20708-3287
Country : US
Telephone Number : 301-825-1982
Fax Number : 443-279-2793
Provider Business Practice Location Address
First Line : 14502 GREENVIEW DR STE 500
Second Line :
City : LAUREL
State : MD
Zip : 20708-4245
Country : US
Telephone Number : 301-825-1982
Fax Number :
Authorized Official
Title or Position : OWNER
Name : TANYA WAGNER
Credential : LICSW, LCSW-I, MSW
Telephone Number : 443-449-8683
Provider Enumeration Date : 12/28/2018
Last Update Date : 08/12/2024

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Directions to “RIVERS OF HEALING LLC ” Practice Location

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