| Living Water Program | |
|
125 Thomas Gantt Rd Huntingtown MD 20639-8545 | |
| (301) 855-1458 | |
| (410) 535-4505 |
| Full Name | Living Water Program |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 125 Thomas Gantt Rd, Huntingtown, Maryland |
| Authorized Official Name and Position | Glinda C. Anderson (CLINCIAL DIRECTOR) |
| Authorized Official Contact | 3018551458 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Water Program 125 Thomas Gantt Rd Huntingtown MD 20639-8545 Ph: (301) 855-1458 | Living Water Program 125 Thomas Gantt Rd Huntingtown MD 20639-8545 Ph: (301) 855-1458 |
| NPI Number | 1619144854 |
|---|---|
| Provider Enumeration Date | 05/15/2008 |
| Last Update Date | 01/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619144854 | NPI | - | NPPES |
| 4004523 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | MD10104401 (Maryland) | Primary |
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