Healthcare Provider Details

I. General information

NPI: 1154872059
Provider Name (Legal Business Name): CLINICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BLACKBURN LN STE 150
BURTONSVILLE MD
20866-6127
US

IV. Provider business mailing address

4000 BLACKBURN LN STE 150
BURTONSVILLE MD
20866-6127
US

V. Phone/Fax

Practice location:
  • Phone: 310-421-4241
  • Fax: 888-317-2075
Mailing address:
  • Phone: 301-421-4241
  • Fax: 888-317-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CHARLES EDMUNDS
Title or Position: HUMAN RESOURCE
Credential:
Phone: 410-372-7628