Healthcare Provider Details

I. General information

NPI: 1386997260
Provider Name (Legal Business Name): JMJ HEALTH CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 02/07/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 LAUREL BOWIE RD STE 209
BOWIE MD
20715-1712
US

IV. Provider business mailing address

6911 LAUREL BOWIE RD STE 209
BOWIE MD
20715-1712
US

V. Phone/Fax

Practice location:
  • Phone: 240-206-8345
  • Fax: 240-245-3064
Mailing address:
  • Phone: 240-206-8345
  • Fax: 240-245-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAMES FONGE
Title or Position: DIRECTOR
Credential:
Phone: 240-206-8345