Provider Demographics
NPI:1922406578
Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Other - Org Name:OASIS YOUTH SERVICES
Other - Org Type:Other Name
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 1:13900 LAUREL LAKES AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5091
Mailing Address - Country:US
Mailing Address - Phone:301-498-4500
Mailing Address - Fax:301-498-4502
Practice Address - Street 1:13900 LAUREL LAKES AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5091
Practice Address - Country:US
Practice Address - Phone:301-498-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCE GEORGES COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-15
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health