Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 07250 | MD |
NPI | 1558740712 |
---|---|
Provider Name | Amanda Parker |
First Address | Columbia, MD 21046-2063 |
Second Address | Columbia, MD 21046-2063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 21/05/2015 |