Provider Demographics
NPI:1598934630
Name:MELWOOD
Entity Type:Organization
Organization Name:MELWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLIE
Authorized Official - Middle Name:WHEATLY
Authorized Official - Last Name:REID
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-870-6722
Mailing Address - Street 1:12705 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3399
Mailing Address - Country:US
Mailing Address - Phone:301-870-6722
Mailing Address - Fax:
Practice Address - Street 1:12705 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3399
Practice Address - Country:US
Practice Address - Phone:301-870-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12188261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)