Doctor Name: | RAMANDA MALLERY PETTIT |
NPI Number: | 1093055642 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | LC5240 |
Business Practice Address: | 603 Post Office Rd Suite 210 Waldorf, MD - 206021914 |
Business Phone Number: | 3017057593 |
Business Fax Number: | |
Mailing Address: | 603 Post Office Rd, Suite 210 WALDORF |
State: | MD |
Postal Code: | 206021914 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/19/2013 |
NPI Last Update Date: | 01/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC5240 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |