Healthcare Provider Details

I. General information

NPI: 1861917395
Provider Name (Legal Business Name): CHILD QUEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 08/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 INDUSTRY LN STE G
FREDERICK MD
21704-5201
US

IV. Provider business mailing address

1416 W 12TH ST
FREDERICK MD
21702-4214
US

V. Phone/Fax

Practice location:
  • Phone: 301-401-4607
  • Fax: 240-668-6767
Mailing address:
  • Phone: 240-285-0080
  • Fax: 240-668-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA TERESA WILLIAMS
Title or Position: OWNER/EDUCATIONAL SPECIALIST
Credential:
Phone: 301-401-4607