Provider Demographics
NPI:1609759877
Name:NWABU HEALING SERVICES
Entity type:Organization
Organization Name:NWABU HEALING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NWABU
Authorized Official - Middle Name:
Authorized Official - Last Name:PHENDULU
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:703-599-7323
Mailing Address - Street 1:15523 GLASTONBURY WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8033
Mailing Address - Country:US
Mailing Address - Phone:703-599-7323
Mailing Address - Fax:
Practice Address - Street 1:15523 GLASTONBURY WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8033
Practice Address - Country:US
Practice Address - Phone:703-599-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty