Provider Demographics
NPI:1225799547
Name:SOVEREIGN CONSULTING GROUP LLC
Entity Type:Organization
Organization Name:SOVEREIGN CONSULTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRETTA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-565-5885
Mailing Address - Street 1:PO BOX 6301
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-6301
Mailing Address - Country:US
Mailing Address - Phone:240-270-1183
Mailing Address - Fax:
Practice Address - Street 1:11110 MALL CIR # 6301
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-1800
Practice Address - Country:US
Practice Address - Phone:240-270-1183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty