Provider Demographics
NPI:1508386079
Name:HOWARD COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:HOWARD COUNTY HEALTH DEPARTMENT
Other - Org Name:WILDE LAKE HIGH SCHOOL-BASED WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLETTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-313-6300
Mailing Address - Street 1:8930 STANFORD BOULEVARD
Mailing Address - Street 2:HOWARD COUNTY HEALTH DEPARTMENT
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5805
Mailing Address - Country:US
Mailing Address - Phone:410-313-7238
Mailing Address - Fax:410-313-6108
Practice Address - Street 1:5460 TRUMPETER ROAD
Practice Address - Street 2:HCHD WILDE LAKE HIGH SCHOOL-BASED WELLNESS CENTER
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2314
Practice Address - Country:US
Practice Address - Phone:410-313-7238
Practice Address - Fax:410-313-6108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-26
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health