Healthcare Provider Details

I. General information

NPI: 1992396568
Provider Name (Legal Business Name): VILLAGE BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5526 BELAIR RD STE 101
BALTIMORE MD
21206-3614
US

IV. Provider business mailing address

5526 BELAIR RD STE 101
BALTIMORE MD
21206-3614
US

V. Phone/Fax

Practice location:
  • Phone: 443-759-4184
  • Fax: 443-376-6999
Mailing address:
  • Phone: 667-225-0081
  • Fax: 443-376-6999

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. OLUWAFEMI AFOLABI
Title or Position: CEO
Credential: BSC
Phone: 667-225-0081