Organization Name: | WALDEN SIERRA CORP |
NPI Number: | 1053611616 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES WOOD (FINANCE DIRECTOR) |
Mailing Address: | 85 High St Suite 4 Waldorf |
State: | MD US |
Postal Code: | 206022150 |
Phone Number: | 3019971300 |
Fax Number: | 3018634744 |
NPI Enumeration Date: | 10/29/2010 |
NPI Last Update Date: | 10/29/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |