Provider Demographics
NPI:1033981113
Name:DZIWULSKI, ANNA (LGPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DZIWULSKI
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:PASSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:6258 HIDDEN CLEARING
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8990 OLD ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2182
Practice Address - Country:US
Practice Address - Phone:443-812-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty