Provider Demographics
NPI:1235683947
Name:WORK LIFE BEHAVIORAL HEALTH AND PROFESSIONAL TRAINING LLC
Entity Type:Organization
Organization Name:WORK LIFE BEHAVIORAL HEALTH AND PROFESSIONAL TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NKONGOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-487-6052
Mailing Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8188
Mailing Address - Country:US
Mailing Address - Phone:410-487-6052
Mailing Address - Fax:
Practice Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 2-C
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8188
Practice Address - Country:US
Practice Address - Phone:410-487-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty