Provider Demographics
NPI:1699289843
Name:BIRDIE'S NEST: THERAPEUTIC AND CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:BIRDIE'S NEST: THERAPEUTIC AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER/ LEAD CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WIGGINS-ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC-S
Authorized Official - Phone:240-523-3381
Mailing Address - Street 1:2612 TALBOT CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4095 SILVER PARK TER
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-3047
Practice Address - Country:US
Practice Address - Phone:240-523-3381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health