Healthcare Provider Details

I. General information

NPI: 1235474818
Provider Name (Legal Business Name): MARYLAND HEALTH ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GREENWAY CENTER DR STE 207
GREENBELT MD
20770-3525
US

IV. Provider business mailing address

7525 GREENWAY CENTER DR STE 207
GREENBELT MD
20770-3525
US

V. Phone/Fax

Practice location:
  • Phone: 240-473-2159
  • Fax: 240-965-6935
Mailing address:
  • Phone: 240-473-2159
  • Fax: 240-965-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. COREY A. WILLIAMS
Title or Position: OWNER
Credential:
Phone: 240-473-2159