Healthcare Provider Details

I. General information

NPI: 1194385138
Provider Name (Legal Business Name): HALCYON CLINICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 MINSTREL WAY STE 204
COLUMBIA MD
21045-5294
US

IV. Provider business mailing address

7135 MINSTREL WAY STE 2024
COLUMBIA MD
21045-5255
US

V. Phone/Fax

Practice location:
  • Phone: 410-855-4631
  • Fax:
Mailing address:
  • Phone: 410-855-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ORLANDO WRIGHT
Title or Position: CEO
Credential: LCSW-C
Phone: 410-855-4631