Provider Demographics
NPI:1710680806
Name:HEALING WOUNDS PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:HEALING WOUNDS PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:DANIELA
Authorized Official - Last Name:CHICA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-825-2041
Mailing Address - Street 1:7406 EDSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1310
Mailing Address - Country:US
Mailing Address - Phone:443-825-2041
Mailing Address - Fax:
Practice Address - Street 1:7406 EDSWORTH RD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1310
Practice Address - Country:US
Practice Address - Phone:443-825-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty