Healthcare Provider Details

I. General information

NPI: 1902477631
Provider Name (Legal Business Name): PSYCHACHE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 MITCHELLVILLE RD # 1043
BOWIE MD
20716-3112
US

IV. Provider business mailing address

4450 MITCHELLVILLE RD # 1043
BOWIE MD
20716-3112
US

V. Phone/Fax

Practice location:
  • Phone: 301-213-5014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY JONES
Title or Position: PRESIDENT & CEO
Credential: LCPC
Phone: 301-213-5014