Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 04010 | MD |
NPI | 1003296617 |
---|---|
Provider Name | Dr. Myra Waters |
First Address | Nottingham, MD 21236-5564 |
Second Address | College Park, MD 20740-1346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2015 |
Last Update Date | 13/04/2017 |