NPIMap

Organization Active NPI

Synergy Wellness Therapeutic Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waldorf, MD
National Provider Identifier
1417517939
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SYNERGY WELLNESS THERAPEUTIC SERVICES
Doing business as
Synergy Wellness Therapeutic Services
Practice address
3195 Old Washington Rd # 227
Waldorf, MD 20602-3201
Phone
(240) 461-1305
NPI assigned
Jun 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Deidra Sorrell, LCPCNPI 1063538791
Title
Owner/Therapist
Phone
(240) 300-3525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

3195 Old Washington Rd # 227
Waldorf, MD 20602-3201

Mailing address

11260 Hess CT
Waldorf, MD 20601-4961
Phone (240) 300-3525

Other identifiers 1

IdentifierTypeStateIssuer
441231100MedicaidMD

Other names 1

  • Synergy Wellness Therapeutic Services Doing business as

National Provider Directory

National Provider Directory

Locations

3195 Old Washington Rd
#227
Waldorf, MD 20602
Phone (240) 461-1305

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560729600000",
    "number": "1417517939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11260 HESS CT",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206014961",
            "telephone_number": "240-300-3525",
            "fax_number": "240-523-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3195 OLD WASHINGTON RD # 227",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023201",
            "telephone_number": "240-461-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY WELLNESS THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A",
        "authorized_official_last_name": "SORRELL",
        "authorized_official_first_name": "DEIDRA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "240-300-3525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "441231100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergy Wellness Therapeutic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.