Healthcare Provider Details

I. General information

NPI: 1922244615
Provider Name (Legal Business Name): MARYLAND TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 CHEVERLY AVE 3RD AND 4TH FLOOR
CHEVERLY MD
20785-3125
US

IV. Provider business mailing address

2801 CHEVERLY AVE 3RD AND 4TH FLOOR
CHEVERLY MD
20785-3125
US

V. Phone/Fax

Practice location:
  • Phone: 301-772-5174
  • Fax: 301-772-5647
Mailing address:
  • Phone: 301-772-5174
  • Fax: 301-772-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4091/22177
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number4091/22177
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4091/22177
License Number StateMD

VIII. Authorized Official

Name: MS. MEGHAN WESTWOOD
Title or Position: CORPORATE DIRECTOR OF MENTAL HEALTH
Credential: LCSW-C
Phone: 301-762-5613