Provider Demographics
NPI:1356710743
Name:GILEAD LIFEWORKS BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:GILEAD LIFEWORKS BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-273-3264
Mailing Address - Street 1:137 NATIONAL PLZ STE 331
Mailing Address - Street 2:NATIONAL HARBOR
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1152
Mailing Address - Country:US
Mailing Address - Phone:240-273-3264
Mailing Address - Fax:240-273-3101
Practice Address - Street 1:8103 BURKART CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2105
Practice Address - Country:US
Practice Address - Phone:240-244-6229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty