Healthcare Provider Details

I. General information

NPI: 1508275074
Provider Name (Legal Business Name): MSA THE CHILD AND ADOLESCENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 OLD COLUMBIA RD SUITE L260
COLUMBIA MD
21046-1702
US

IV. Provider business mailing address

10005 OLD COLUMBIA RD SUITE L260
COLUMBIA MD
21046-1702
US

V. Phone/Fax

Practice location:
  • Phone: 443-259-0400
  • Fax:
Mailing address:
  • Phone: 443-259-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLC5864
License Number StateMD

VIII. Authorized Official

Name: MR. MARTIN SLUTSKY
Title or Position: OWNER
Credential:
Phone: 443-259-0400