Healthcare Provider Details

I. General information

NPI: 1831742824
Provider Name (Legal Business Name): KIRSTIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ALLENTOWN RD STE 310&311
CAMP SPRINGS MD
20746-4563
US

IV. Provider business mailing address

5801 ALLENTOWN RD STE 310&311
CAMP SPRINGS MD
20746-4563
US

V. Phone/Fax

Practice location:
  • Phone: 240-392-2876
  • Fax: 240-838-3015
Mailing address:
  • Phone: 240-392-2876
  • Fax: 240-838-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. STEPHEN F FONCHAM
Title or Position: FOUNDER/CEO/PRESIDENT
Credential: MBA
Phone: 240-392-2876