Healthcare Provider Details

I. General information

NPI: 1255442323
Provider Name (Legal Business Name): BEHAVIORAL HEALTH AND SUBSTANCE ABUSE NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST NE
WASHINGTON DC
20002-1241
US

IV. Provider business mailing address

9639 OXBRIDGE WAY
BOWIE MD
20721
US

V. Phone/Fax

Practice location:
  • Phone: 301-613-2750
  • Fax: 301-386-3521
Mailing address:
  • Phone: 301-613-2750
  • Fax: 301-386-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078081
License Number StateDC

VIII. Authorized Official

Name: MR. BENJAMIN WILLSON SWAIN
Title or Position: PRESIDENT AND CEO
Credential: LICSW, ICADC,CADC II
Phone: 301-613-2750