Healthcare Provider Details

I. General information

NPI: 1225789498
Provider Name (Legal Business Name): FAMILY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 TWIN KNOLLS RD STE 323
COLUMBIA MD
21045-3207
US

IV. Provider business mailing address

702 RUSSELL AVE STE 100
GAITHERSBURG MD
20877-2605
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-0006
  • Fax: 301-330-0444
Mailing address:
  • Phone: 301-330-0006
  • Fax: 301-330-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: EUNICE HE
Title or Position: MEDICAL BILLING MANAGER
Credential:
Phone: 301-330-0006