NPIMap

Organization Active NPI

Illumine LLC

  • Professional Counselor
  • Waldorf, MD
National Provider Identifier
1750742664
Registry record updated Mar 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LC2196 Issued in MD
Legal business name
ILLUMINE LLC
Practice address
605 Post Office Rd Ste 301
Waldorf, MD 20602-1913
Phone
(301) 928-6045
NPI assigned
Mar 19, 2016
Last updated
Mar 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2016

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

Authorized official

Name
Dr. Wade Morgan Green Jr., PSYD., LCPC-SNPI 1033221676
Title
Partner
Phone
(301) 928-6045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X LC2196 MD Primary

Addresses

Primary practice location

605 Post Office Rd Ste 301
Waldorf, MD 20602-1913

Mailing address

605 Post Office Rd Ste 301
Waldorf, MD 20602-1913
Phone (301) 928-6045

National Provider Directory

National Provider Directory

Locations

605 Post Office Rd
Ste 301
Waldorf, MD 20602
Phone (240) 346-0934

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1458345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458345600000",
    "number": "1750742664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 POST OFFICE RD STE 301",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021913",
            "telephone_number": "301-928-6045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 POST OFFICE RD STE 301",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206021913",
            "telephone_number": "301-928-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-19",
        "last_updated": "2016-03-19",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "MORGAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "301-928-6045",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PSYD., LCPC-S"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC2196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 19, 2016; 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.