Healthcare Provider Details

I. General information

NPI: 1023698362
Provider Name (Legal Business Name): FAMILYCHOICE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 YORK RD
BALTIMORE MD
21212-3804
US

IV. Provider business mailing address

5513 YORK RD
BALTIMORE MD
21212-3804
US

V. Phone/Fax

Practice location:
  • Phone: 443-825-2955
  • Fax: 667-212-2682
Mailing address:
  • Phone: 667-212-2682
  • Fax: 443-835-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARET T T OWOLABI
Title or Position: DIRECTOR
Credential:
Phone: 443-825-2955