Provider Demographics
NPI:1770145500
Name:WONDROUS HEIGHTS COUNSELING LLC
Entity type:Organization
Organization Name:WONDROUS HEIGHTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUZILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-725-8468
Mailing Address - Street 1:12610 EASTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2041
Mailing Address - Country:US
Mailing Address - Phone:202-725-8468
Mailing Address - Fax:
Practice Address - Street 1:7825 TUCKERMAN LN STE 209
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3241
Practice Address - Country:US
Practice Address - Phone:240-645-8575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty