Provider Demographics
NPI:1457474017
Name:D.A. WYNNE & ASSOCIATES,INC.
Entity Type:Organization
Organization Name:D.A. WYNNE & ASSOCIATES,INC.
Other - Org Name:SILVER SPRING OUTPATIENT TREATMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LCADC
Authorized Official - Phone:301-439-6700
Mailing Address - Street 1:10230 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1400
Mailing Address - Country:US
Mailing Address - Phone:301-439-6700
Mailing Address - Fax:301-439-5755
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1400
Practice Address - Country:US
Practice Address - Phone:301-439-6700
Practice Address - Fax:301-439-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903158103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty