Provider Demographics
NPI:1558715326
Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WRIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-883-7903
Mailing Address - Street 1:501 HAMPTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3802
Mailing Address - Country:US
Mailing Address - Phone:301-324-2872
Mailing Address - Fax:301-324-2850
Practice Address - Street 1:501 HAMPTON PARK BLVD
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3802
Practice Address - Country:US
Practice Address - Phone:301-324-2872
Practice Address - Fax:301-324-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0512251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management