Doctor Name: | TOWANDA STREET |
NPI Number: | 1740520360 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 6665 Security Boulevard Woodlawn, MD - 21207 |
Business Phone Number: | 4102657291 |
Business Fax Number: | 4102657294 |
Mailing Address: | 6665 Security Boulevard, WOODLAWN |
State: | MD |
Postal Code: | 21207 |
Phone Number: | 4102657291 |
Fax Number: | 4102657294 |
NPI Enumeration Date: | 02/19/2013 |
NPI Last Update Date: | 02/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |