Healthcare Provider Details

I. General information

NPI: 1659626356
Provider Name (Legal Business Name): FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E. DIAMOND AVE SUITE B
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: 240-686-0707
  • Fax: 240-686-0711
Mailing address:
  • Phone: 301-840-2000
  • Fax: 301-840-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number904701
License Number StateMD

VIII. Authorized Official

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