| Prince George's County | |
|
337 Brightseat Rd Sutie 106 And 107 Landover MD 20785-4736 | |
| (301) 499-1474 | |
| (301) 499-0145 |
| Full Name | Prince George's County |
|---|---|
| Speciality | Psychologist - Group Psychotherapy |
| Location | 337 Brightseat Rd, Landover, Maryland |
| Authorized Official Name and Position | Randall Cooper (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4107789114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prince George's County Po Box 690 Chestertown MD 21620-0690 Ph: (410) 778-9114 | Prince George's County 337 Brightseat Rd Sutie 106 And 107 Landover MD 20785-4736 Ph: (301) 499-1474 |
| NPI Number | 1477613578 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477613578 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | (Maryland) | Primary |
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