Provider Demographics
NPI:1316586688
Name:PRYOR, MONTRELL (MED, LMSW)
Entity Type:Individual
Prefix:
First Name:MONTRELL
Middle Name:
Last Name:PRYOR
Suffix:
Gender:M
Credentials:MED, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 WOODSIDE CT STE 110G
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3217
Mailing Address - Country:US
Mailing Address - Phone:410-855-4631
Mailing Address - Fax:
Practice Address - Street 1:712 H ST NE STE 2884
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3627
Practice Address - Country:US
Practice Address - Phone:615-635-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000029641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty