Provider Demographics
NPI:1124115811
Name:HOLDER, WENDY LYNN (LCSWC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:LYNN
Other - Last Name:SCARBOROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:2336 GODDARD PARKWAY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6362
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147000OtherMAGELLAN GROUP
MD521256095OtherAMERICAN PSYCH SYSTEM
MD609550004Medicaid
MD733940-000OtherMAGELLAN PIN
517251OtherUHC MAMSI GROUP #
MD609550001Medicaid
MDLM49EAOtherCAREFIRST BCBS GROUP
R968OtherCARE1ST FEDERAL GROUP DC
MD640984-02OtherCAREFIRST BCBS PIN
MD609550002Medicaid
MD522156095OtherUNITED BEHAVIORAL HEALTH
MD522156095OtherNCPPO
MD0030OtherCAREFIRST BCBS FEDERAL
MD609550002Medicaid