CREATE YOUR LIFE, LLC


Address: 5008 Vane Ct, Suite 2041, Waldorf, MD 20602-1526
Phone: 2024227337

CREATE YOUR LIFE, LLC (NPI# 1639529407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1639529407
Entity Type Organization
Organization Name CREATE YOUR LIFE, LLC
Practice Address 5008 Vane Ct
Suite 2041
Waldorf
MD 20602-1526
Practice Telephone 2024227337
Mailing Telephone 2024227337
Enumeration Date 2016-06-13
Last Update Date 2016-06-22
Authorized Official Name DR. SHANNON DARLENE HOWARD (LIC.CLIN. PROF. COUNSELOR)
Authorized Official Telephone 2024227337
Authorized Official Credential LCPC, LPC
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 101YP2500X Counselor
Specialization: Professional
PRC13741 DC Behavioral Health & Social Service Providers
Y 101YP2500X Counselor
Specialization: Professional
LC1508 MD Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
MD MAGELLEAN 743688000 01
MD BLUE CROSS BLUE SHIELD 645523-03 01
MD MHN 358105 01
MD MAMSI 2132324 01
MD 001437100 05
DC BLUE CROSS BLUE SHIELD 60980001 01

Office Location

Street Address 5008 VANE CT
SUITE 2041
City WALDORF
State MD
Zip Code 20602-1526

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1053964957 Haeyoung Choi Pharmacist 25 Smallwood Village Center, Waldorf, MD 20602 2019-07-19
1679137194 Brighter Days Family Services Inc Counselor 11680 Doolittle Dr #111, Waldorf, MD 20602 2019-04-30
1396227039 Lantern Family Services Inc Community/Behavioral Health 11680 Doolittle Dr Ste 111, Waldorf, MD 20602 2018-08-29
1093294910 Metropolitan Vascular Institute LLC Internal Medicine 12070 Old Line Ctr Ste 100, Waldorf, MD 20602 2018-08-10
1174009922 Dr. Arthur B. Sorkin, D.d.s., LLC Dentist 3460 Old Washington Rd., Suite 301-b, Waldorf, MD 20602 2018-07-16
1467945030 Donna Marie Conley-shaw Behavior Technician 16 Pagnell Cir, Waldorf, MD 20602 2018-06-08
1811404296 Loni Berbaum Speech-Language Pathologist 4817 Elmley Pl Apt 315, Waldorf, MD 20602 2018-01-06
1891224853 Linda E Smith Social Worker 605 Pst Office Road, #301, Waldorf, MD 20602 2017-06-05
1104373273 Love Ngum Che Pharmacist 25 Smallwood Village, Waldorf, MD 20602 2016-09-07
1639543341 Matengy Toure Pharmacist 129 St Charles Pkwy, Waldorf, MD 20602 2015-11-18
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Taxonomy Information

Taxonomy Code 101YP2500X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Professional

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1669088803 Jennifer Silver Counselor 12722 Country Ln, Waldorf, MD 20601-3338 2020-09-22
1700401692 Teresa Allen Counselor 11100 Billingsley Rd, Waldorf, MD 20602-3400 2020-06-16
1215578398 Curtrice Scott Counselor 10382 Cassidy Ct, Waldorf, MD 20601-3762 2019-09-30
1679137194 Brighter Days Family Services Inc Counselor 11680 Doolittle Dr #111, Waldorf, MD 20602 2019-04-30
1861845067 Chanell Gaines Counselor 11605 Lewisham Pl, #109, Waldorf, MD 20602-5135 2016-07-22
1053787416 Lysa Kirby Counselor 2369 Walbrook Ct, Waldorf, MD 20602-2148 2015-08-19
1396122198 Deborah Bernetta Allen Counselor 1282 Smallwood Dr W # 317, Waldorf, MD 20603-4732 2015-04-30
1073931432 Beata Kinsey Counselor 1742 Temi Dr, Waldorf, MD 20601-3382 2014-04-02
1942636253 Richella N Washington Counselor 3261 Old Washington Road, Suite 2020, Waldorf, MD 20602 2013-09-18
1427323336 Dawn of A New Day Pastoral Counseling & Mentoring Services Counselor 3225 Old Washington Rd, 107, Waldorf, MD 20602-3202 2012-03-12
Find all providers in WALDORF

Competitor

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City WALDORF
Zip Code 20602

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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