Organization Name: | LIVING WATER PROGRAM |
NPI Number: | 1619144854 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLINDA C. ANDERSON (CLINCIAL DIRECTOR) |
Mailing Address: | 125 Thomas Gantt Rd Huntingtown |
State: | MD US |
Postal Code: | 206398545 |
Phone Number: | 3018551458 |
Fax Number: | 4105354505 |
NPI Enumeration Date: | 05/15/2008 |
NPI Last Update Date: | 05/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | MD10104401 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |