Healthcare Provider Details

I. General information

NPI: 1073002762
Provider Name (Legal Business Name): BK BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 PENNSYLVANIA AVE., SUITE 102
BALTIMORE MD
21217-4958
US

IV. Provider business mailing address

1805 PENNSYLVANIA AVE., SUITE 102
BALTIMORE MD
21217-4958
US

V. Phone/Fax

Practice location:
  • Phone: 240-360-2637
  • Fax: 240-360-2647
Mailing address:
  • Phone: 240-360-2637
  • Fax: 240-360-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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