Provider Demographics
NPI:1609938992
Name:PRINCE GEORGE'S COUNTY HEALTH DEPT.
Entity Type:Organization
Organization Name:PRINCE GEORGE'S COUNTY HEALTH DEPT.
Other - Org Name:CHILDREN AND PARENTS PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WRIGHT
Authorized Official - Middle Name:F
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:301-324-2832
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:301-324-2832
Practice Address - Fax:301-324-2850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCE GEORGE'S COUNTY HEALTH DEPT.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD588361000Medicaid
MD588971500Medicaid