Healthcare Provider Details

I. General information

NPI: 1912580218
Provider Name (Legal Business Name): CLINICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
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 200
BURTONSVILLE MD
20866-1104
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-4241
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CHARLES EDMUNDS
Title or Position: CHIEF FINANCIAL OFFICE/OWNER
Credential:
Phone: 410-372-7628