Provider Demographics
NPI:1124234265
Name:WORDS OF LIFE DEVELOPMENT CENTER, LLC
Entity type:Organization
Organization Name:WORDS OF LIFE DEVELOPMENT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:240-297-3988
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-0401
Mailing Address - Country:US
Mailing Address - Phone:240-297-3988
Mailing Address - Fax:240-206-9796
Practice Address - Street 1:7829 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3338
Practice Address - Country:US
Practice Address - Phone:240-297-3988
Practice Address - Fax:240-206-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYI000077103T00000X
MD03769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$OtherSSN
DC$$$$$$$$$OtherSSN