Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | R151970 | MD |
NPI | 1003113739 |
---|---|
Provider Name | Mrs. Dianne Woods |
First Address | Garrett Park, MD 20896-0113 |
Second Address | Kensington, MD 20895-3941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2011 |
Last Update Date | 15/02/2011 |