Healthcare Provider Details

I. General information

NPI: 1861410128
Provider Name (Legal Business Name): THE FAMILY SERVICES AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E DIAMOND AVE SUITE 100
GAITHERSBURG MD
20877-5321
US

IV. Provider business mailing address

610 E DIAMOND AVE SUITE 100
GAITHERSBURG MD
20877-5321
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3268
  • Fax: 301-840-1348
Mailing address:
  • Phone: 301-840-3268
  • Fax: 301-840-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10406
License Number StateMD

VIII. Authorized Official

Name: THOM HARR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-840-3202