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2 Industrial Park Dr Ofc 4 Waldorf MD 20602-2729 | |
| (301) 276-1151 | |
| (443) 440-5682 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2 Industrial Park Dr Ofc 4, Waldorf, Maryland |
| Authorized Official Name and Position | Camille Lewis (OWNER/PRACTITIONER) |
| Authorized Official Contact | 3012761151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2 Industrial Park Dr Ofc 4 Waldorf MD 20602-2729 Ph: (301) 276-1151 | 2 Industrial Park Dr Ofc 4 Waldorf MD 20602-2729 Ph: (301) 276-1151 |
| NPI Number | 1609503192 |
|---|---|
| Provider Enumeration Date | 08/04/2022 |
| Last Update Date | 01/28/2025 |
| Certification Date | 01/28/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609503192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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