MEDICARE: FAMILY CRISIS CENTER OF PRINCE GEORGES' COUNTY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC301226	DC

General Provider Information

NPI Number	:	1962892851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CRISIS CENTER OF PRINCE GEORGES' COUNTY, INC.

Provider Business Mailing Address
First Line	:	3601 TAYLOR ST
Second Line	:
City	:	BRENTWOOD
State	:	MD
Zip	:	20722-1300
Country	:	US
Telephone Number	:	301-779-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 TAYLOR ST
Second Line	:
City	:	BRENTWOOD
State	:	MD
Zip	:	20722-1300
Country	:	US
Telephone Number	:	301-779-2100
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SOPHIE FORD
Credential	:
Telephone Number	:	301-779-2100

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	01/29/2015

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