Healthcare Provider Details

I. General information

NPI: 1003151291
Provider Name (Legal Business Name): FAMILY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 RUSSELL AVE STE 100
GAITHERSBURG MD
20877-2605
US

IV. Provider business mailing address

702 RUSSELL AVE STE 100
GAITHERSBURG MD
20877-2605
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-0006
  • Fax: 301-330-0444
Mailing address:
  • Phone: 301-330-0006
  • Fax: 301-330-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GENNADY VINOKUR
Title or Position: MANAGER
Credential:
Phone: 301-330-0006