Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 05151 | MD |
Y | 103T00000X | Psychologist | 05151 | MD |
NPI | 1003388711 |
---|---|
Provider Name | Renee Michelle Neely-Walters |
First Address | District Heights, MD 20747-1259 |
Second Address | Washington, DC 20011-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2018 |
Last Update Date | 19/12/2018 |