Provider Demographics
NPI:1639647183
Name:D.A. WYNNE & ASSOCIATES,INC.
Entity Type:Organization
Organization Name:D.A. WYNNE & ASSOCIATES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-439-6700
Mailing Address - Street 1:10230 NEW HAMPSHIRE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1423
Mailing Address - Country:US
Mailing Address - Phone:301-439-6700
Mailing Address - Fax:
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE STE 206
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1423
Practice Address - Country:US
Practice Address - Phone:301-439-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD954067900Medicaid