Healthcare Provider Details

I. General information

NPI: 1386242006
Provider Name (Legal Business Name): ABREAST THERAPEUTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 02/09/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9418 ANNAPOLIS RD STE 202
LANHAM MD
20706-3053
US

IV. Provider business mailing address

9418 ANNAPOLIS RD STE 202
LANHAM MD
20706-3053
US

V. Phone/Fax

Practice location:
  • Phone: 240-764-5180
  • Fax: 240-467-3981
Mailing address:
  • Phone: 240-764-5180
  • Fax: 240-467-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABAYOMI SOKOYA
Title or Position: PRESIDENT
Credential:
Phone: 240-764-5180