Healthcare Provider Details

I. General information

NPI: 1285312678
Provider Name (Legal Business Name): STEPPING STONE TREATMENT PROGRAM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E DIAMOND AVE STE A
GAITHERSBURG MD
20877-5326
US

IV. Provider business mailing address

12 E DIAMOND AVE STE A
GAITHERSBURG MD
20877-5326
US

V. Phone/Fax

Practice location:
  • Phone: 301-366-0226
  • Fax:
Mailing address:
  • Phone: 301-366-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMY QUIROZ-FLORES
Title or Position: CEO
Credential:
Phone: 240-330-3609