Healthcare Provider Details

I. General information

NPI: 1295194371
Provider Name (Legal Business Name): FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EAST DIAMOND AVE
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: 301-840-3292
  • Fax: 301-963-6237
Mailing address:
  • Phone: 301-840-2000
  • Fax: 301-840-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number588881600
License Number StateMD

VIII. Authorized Official

Name: MRS. KYLIE MCCLEAF
Title or Position: CEO
Credential:
Phone: 301-840-3267