Healthcare Provider Details

I. General information

NPI: 1902383318
Provider Name (Legal Business Name): ACC PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 LIBERTY RD STE 105
ELDERSBURG MD
21784-6545
US

IV. Provider business mailing address

1643 LIBERTY RD STE 105
ELDERSBURG MD
21784-6545
US

V. Phone/Fax

Practice location:
  • Phone: 443-920-5333
  • Fax: 443-920-5334
Mailing address:
  • Phone: 443-920-5333
  • Fax: 443-920-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREW COLE
Title or Position: OWNER
Credential: CRNP-PMH
Phone: 443-920-5333