Healthcare Provider Details

I. General information

NPI: 1366938599
Provider Name (Legal Business Name): DMV COMMUNITY HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 09/12/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE STE 300
BALTIMORE MD
21229-5214
US

IV. Provider business mailing address

3455 WILKENS AVE STE 300
BALTIMORE MD
21229-5214
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-2762
  • Fax:
Mailing address:
  • Phone: 443-622-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
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: MRS. CATHY LORRAINE LEMON
Title or Position: OWNER
Credential:
Phone: 443-622-2762