Healthcare Provider Details

I. General information

NPI: 1154770527
Provider Name (Legal Business Name): PROJECT CHESAPEAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710-5712 RITCHIE HWY
BROOKLYN PARK MD
21225-3641
US

IV. Provider business mailing address

185 ADMIRAL COCHRANE DR STE 225
ANNAPOLIS MD
21401-7583
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-5600
  • Fax:
Mailing address:
  • Phone: 443-440-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA PETERSON
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 443-440-5782