Healthcare Provider Details

I. General information

NPI: 1386324770
Provider Name (Legal Business Name): BK BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 BELLONA AVE
BALTIMORE MD
21212-3561
US

IV. Provider business mailing address

7404 EXECUTIVE PL STE 250
LANHAM MD
20706-6221
US

V. Phone/Fax

Practice location:
  • Phone: 240-360-2637
  • Fax:
Mailing address:
  • Phone: 240-360-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE S KAMARA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-346-4687